Discussion: Cultural Diversity in Healthcare Discussion

Discussion: Cultural Diversity in Healthcare Discussion ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Cultural Diversity in Healthcare Discussion Discussion Topic: Team Diversity After reading the article, take some time to reflect on cultural diversity in healthcare, then answer substantively to the following questions. Discussion: Cultural Diversity in Healthcare Discussion What is your definition of diversity? Explain in your own words. What is the author’s definition of cultural competence? Roxelle cited Bacote (2003) cultural competence model. Use these competencies to demonstrate why you, as the nurse manager believe this cultural competence model could contribute to decision-making by members who care for patients on your nursing unit? advocacy_in_nursing_article.pdf naq_03639568_2019_43_3_256.pdf ncm_15297764_2018_23_5_276.pdf LEADING THE WAY Advocacy: A lifetime commitment Leading nurses through crisis, disaster, and everyday practice. TEXAS NURSES ASSOCIATION (TNA) CEO Cindy Zolnierek, PhD, RN, CAE, started her nursing career at a small rural hospital in northern Michigan, served as a full-time professor, and held leadership positions in hospitals in Michigan and California. At every step of her career, she took on volunteer advocacy roles with nursing organizations. The American Nurses Association (ANA) spoke with Zolnierek about her commitment to advocacy. How did your career path lead you to advocacy? In nursing school at Mercy College (now the University of Detroit Mercy), I took a course called women, policy, and power that had a big influence on me. I believe that we, as nurses, have a responsibility to our profession. That’s why I’ve always been active in my professional associations. I got involved with TNA as director of practice in 2007. In that role, I had the opportunity to influence the care given by every licensed nurse in the state. As nurses, that’s what we hold near and dear; we want to make a difference in people’s lives. When the long-time executive director of TNA retired, I was selected as executive director in 2013, then became chief executive officer (CEO) in 2018. I feel like it’s the perfect culmination of my career. What leadership lessons did you take away from the Ebola crisis and Hurricane Harvey? The lesson I learned during the Ebola crisis is that when the community is afraid, the media frequently will look for someone to blame. The Dallas nurse who saw our first Ebola patient noted in the electronic health record (EHR) that the patient had traveled to a country where Ebola was present. Unfortunately, that data didn’t appear when the physician looked at the EHR, so the patient was released. In a live interview I gave on a national network about that situation, the interviewer kept MyAmericanNurse.com suggesting that it was the nurse’s fault. I had to be very mindful to stay on message. It’s not useful to blame the nurse for not doing more when it was the EHR system that failed. During Hurricane Harvey, our efforts were largely focused on directing nurses who wanted to volunteer to the state’s emergency response registry so they could be sent to where they were needed. Some of these nurses were stranded at their hospital work sites for days, unable to care for their own loved ones and property while caring for others. To help support them, the Texas Nurses Foundation raised money with small to large donations from all over the country. Discussion: Cultural Diversity in Healthcare Discussion How can nurses develop their advocacy muscle to advance professional practice? Nurses understand patient advocacy but may not see the importance of applying their advocacy skills to the policy realm. But that’s how you improve patient care—by improving the nursing practice environment through broader advocacy. The best opportunity for nurses to get involved is through their professional associations. I recommend that nurses attend their state association’s lobby day or Hill Day at the U.S. Capitol. That’s a pivotal event that inspires nurses to champion issues such as workplace violence and full practice authority. What can leaders do to foster growth in their Constituent and State Nurses Association (C/SNA)? Nurse leaders should talk about the specific value their C/SNA brings to the profession. Nurses have certain protections because of their state association’s advocacy. In Texas, we constantly work to strengthen our practice act and have fought against harmful changes that others wanted to make. I tell nurses they should belong to both specialty and umbrella organizations. ANA and state associations together take care of things that affect all RNs. AN April 2020 American Nurse Journal 21 Nurs Admin Q Vol. 43, No. 3, pp. 256–262 c 2019 Wolters Kluwer Health, Inc. All rights reserved. Copyright Telehealth Disrupting Time for Health Care Quantity and Quality Brooke A. Finley, MSN, PMHNP-BC, RN-BC; Kimberley D. Shea, PhD, RN, CHPN Telehealth, de?ned simply as the delivery of health care services over a distance by using telecommunication technology, has become one of the most disruptive innovations in modern health care. This article explores the history and impact telehealth has had on provider and consumer supply and demand for time, becoming a widely adopted technological health care service delivery model that has demonstrated signi?cant benevolent contributions to the health care industry and the patients it serves. Key words: disruptive innovation, eHealth, mHealth, mobile health, telehealth, telemedicine I T WAS ONLY 40 years ago that health care was ?rst identi?ed as a business. Currently, US health care expenditures are well over $3 trillion.1 In 2018, health care became the largest employer in the United States.2 Clearly, regardless of their multiple missions, including goals to serve the common good or to address the needs of the poor and vulnerable, organizations that provide care are economic entities. Successful companies in all business sectors survive and thrive through adaptation to a changing world. Health care organizations are no exception. They must utilize technology to remain effective, ef?cient, and competitive. This article explores the theory of disruptive innovation and how it relates to the supply and demand for “time” in the health care market. It also describes how telehealth, Author Af?liations: The University of Arizona College of Nursing, Tucson, Arizona (Ms Finley and Dr Shea); and Scottsdale Mental Health and Wellness Institute, Scottsdale, Arizona (Ms Finley). The authors declare no con?ict of interest. Correspondence: Brooke A. Finley, MSN, PMHNP-BC, RN-BC, The University of Arizona College of Nursing, 1305 N. Martin, PO Box 210203, Tucson, AZ 85721 ([email protected]). DOI: 10.1097/NAQ.0000000000000357 de?ned simply as using teleconferencing technology to deliver health care services at a distance, is a prime example of disruptive technology that improves the health care industry by promoting access to care, improving service quality and quantity, targeting chronic conditions, and creating a new competitive business niche. Discussion: Cultural Diversity in Healthcare Discussion# Harvard professor Clayton M. Christensen coined “disruptive innovation,” and publicized disruption theory in 1995. The Cambridge Dictionary describes his concept as, “Changing the traditional way that an industry operates, especially in a new and effective way.”3,4 In a 2015 Harvard Business Review article, Christensen et al4 further expanded on this de?nition. They described a disruptor as a new competitor who targets an overlooked segment of the market by providing a suitable option for new- or low-end customers. They suggested that this option is likely to be offered at a reduced price due to being considered lower quality than the standard offering. Meanwhile, incumbent (nondisruptive) companies continue focusing on more profitable, higher-demand services. Only until the new competitor moves upmarket, and mainstream customers begin using the new offering in a high volume does disruption actually occur.4 256 Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Telehealth According to Christensen et al,4 Uber, the San Francisco-based ride-share company, is frequently, but incorrectly, cited as an example of disruptive innovation. Uber transformed, but did not actually disrupt, the transportation market.4 Uber is not disruptive, because it generally has not established a new foothold for nonconsumers (ie, those who use Uber were already using cabs). It also does not provide services to low-end customers, as its user base is mainly middle-to-upper class. Nor is it mostly viewed as inferior to traditional cab services. (Uber has high user satisfaction overall.) In contrast, the personal photocopier was technically a disruptive innovation because it collapsed Xerox’s market in the 1970s after being adopted by large companies. This followed adoption by a base of small businesses that could not afford Xerox technology and used the low-cost personal photocopiers as an alternative.4 In health care, telehealth emerged across silo pilot projects in the 1950s and has now spread across the nation, demonstrating qualities of a disruptive innovation because while it will not replace all face-to-face clinician visits, its adoption will spread, and it will continue to transform the health care system.5 TIME SUPPLY AND DEMAND CREATING TELEHEALTH DISRUPTIVE INNOVATION In the early 1900s, health care was delivered by trained providers who made “housecalls.”6 As populations increased, and residential areas grew in size, the family doctor could not visit all patients who needed care. The number of patients exceeded the time available for in-home visits.6 In addition, it became more burdensome and timeconsuming to pack and carry the increasing number of new and various devices available for assessing patients.7 To increase the ability to care for their communities, health care providers set up in-home of?ces so they could see more patients daily.6 By allowing patients to come to them, physicians replaced the established method of in-home care. This simple change demon- 257 strated Christensen’s theory that innovation gains a foothold by delivering increased functionality. It de?nitely increased the physician’s time to spend on patient care.6 By the 1960s, housecalls had declined to where they were nearly nonexistent. Hospitals and clinics became the health care hubs.8 As a result, the economics surrounding health care changed in a fundamental way. Discussion: Cultural Diversity in Healthcare Discussion Established care delivery sites have now become the primary care or specialist providers’ of?ces. However, new technologies (such as telehealth) are creating a market for disruptive innovation to this model.9,10 Disruptive innovations usually occur in smaller, more ?exible organizations. They start as experiments, are adopted by smaller markets, and, later, reach mass level of mainstream preference.4 First-generation telehealth began in the 1950s and 1960s, when the University of Nebraska used a 2-way interactive television system to share neurological examinations across campus. The University later used television for interactive group therapy. Meanwhile, the National Institutes of Mental Health was supporting closed-circuit telephonic systems among 7 state hospitals. In-house patient monitoring was supported via television, followed by interactive, closedcircuit applications.5 Concurrently, remote monitoring of vital signs began when the National Aeronautics and Space Administration (NASA) pioneered a remote-monitoring pilot project to keep track of astronauts’ heart rate, blood pressure, temperature, and respiration rate.4,5,11 By the 1970s, more advanced telehealth delivery was created and adopted, including specialty services like teleradiology, teledermatology, and telepathology.5 Support from larger, system-based programs, such as those in the US Department of Defense and US Department of Veterans Affairs (VA), expanded telehealth beyond pilot projects, and started multiapplication telehealth systems for broader implementation across more specialties.11 However, it was not until the 1990s that private and public telehealth adoption expanded alongside internet advancement. New infrastructures supported Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. 258 NURSING ADMINISTRATION QUARTERLY/JULY–SEPTEMBER 2019 telehealth, making it affordable, sustainable, and usable by a broader market.11 Since 2000, telehealth adoption has rapidly expanded. It demonstrates feasibility, program sustainability, provider and patient satisfaction, and noninferiority to face-to-face care. It promises to reach underserved areas, and is becoming a hallmark health care disruptive innovation that improves patient health.5,11-13 Telehealth is transcending geographical boundaries, establishing best-practices, expanding across specialties, and garnering high satisfaction among both providers and patients. It also has a projected $19.5 billion market by 2025.5,11,14,15 Although many commercial insurances, large employers, and the Veterans Administration (VA) utilize and reimburse for an array of telehealth services, the Centers for Medicaid & Medicare (CMS) has not supported its use until recently.16-19 CMS telehealth adoption is hindered by regulations that restrict originating sites, de?ned as the location the patient is receiving telehealth services, to only 8 health care settings including of?ces of physicians and practitioners, hospitals, critical access hospitals, federally quali?ed health centers, hospital-based critical access renal dialysis centers (including satellites), rural health clinics, community mental health centers, and skilled nursing facilities.17 Furthermore, these originating sites must be located in a rural health professional shortage area, site participating in a Federal telemedicine project funded by the Secretary of Health and Human Services, or located in a county outside of a Metropolitan Statistical Area.17 As a result, only 0.25% of Medicare bene?ciaries (90 000 of 35 million fee-for-service bene?ciaries) utilized covered telehealth services in 2016.17 If only 1% of all current faceto-face Medicare encounters were conducted through telehealth, utilization would increase 13-fold.17 In response, the CMS is now sponsoring telehealth innovation. Discussion: Cultural Diversity in Healthcare Discussion It is waiving originating site requirements, and is testing services through the Innovation Center’s Next Generation Accountable Care Organization Model, which utilizes telehealth in various set- tings, including the home.17 In 2019, the CMS agreed to cover 97 different telehealth Current Procedural Terminology (CPT) codes.20 The organization may eventually follow the VA, which had 12% of its members receive telehealth care in 2016.16 Telehealth has become more mainstream and is becoming the type of health care delivery that patients (especially women younger than 40 years) and providers are demanding.12,15,16,18,19,21 CURRENT HEALTH CARE CLIMATE POISED FOR TELEHEALTH DISRUPTION Health care commodi?cation has emphasized consumer needs, demands, and satisfaction with resulting prioritization for patients’ convenience, choice, and control across health care services.18,22 After the Institutes of Medicine published Crossing the Quality Chasm: A New Health System for the 21st Century in 2001, health care began to focus on 6 guiding principles for safe, effective, patient-centered, timely, ef?cient, and equitable health care.22 Subsequent reactions have included the Institute for Healthcare Improvement’s Triple (now Quadruple) Aim, focusing on value, improved population health, better patient satisfaction and experience, and provider well-being; the expansion of health care access via the Affordable Care Act of 2010; and the CMS meritbased payment restructuring.17,22 The $25.9 billion allotted for improving health information technology has encouraged technology adoption. This has positioned telehealth to positively disrupt the health care system to meet current priorities of both consumers and health care businesses.22,23 More robust telehealth business modeling, clinical practice and ethics guidelines, outcome measures, research, training, accreditations, and standards are being created and employed to continue improving this service model.22-27 Eventually, telehealth may be the preferred health care modality as digital natives with longer life expectancies become the majority of the American population.22 Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Telehealth TELEHEALTH MEETING DEMAND FOR PATIENT-CENTERED CARE Telehealth supports patient-centered care by increasing patient empowerment. It offers improved access, choice, continuity of care, and direct connections with providers through technological services.23 Patients can access on-demand and specialty services from multiple environments or chosen locations (homes, work sites, long-term care facilities, emergency departments, primary care of?ces, shelters, schools, prisons, or battlefronts). They no longer need to travel to visit a provider.23 For people who are immobilized, have debilitating diseases, and/or are located in areas with a lack of specialists (or long waits to see specialists), telehealth makes treatment accessible and timely.23 In addition, telehealth can increase care to at-risk populations while reducing hospitalizations and acute illness episodes. This results through early warning systems, remote monitoring, and preventive care models that allow subtle changes in condition to be monitored and assessed in a timely fashion. As a result, medication management, lifestyle intervention, and treatments can occur promptly and quickly.Discussion: Cultural Diversity in Healthcare Discussion 5 Telehealth has also become a priority among employers who want to ensure employee wellness.18 Through this innovation, culturally sensitive care can be delivered over a distance. Speci?c customer preferences that may not be available in a local area can be offered, as well as verbal communication in various native languages.23 Financially, there are relatively low barriers to access telehealth. The only equipment usually needed for patients are smartphones or computers with internet services. These have become commonplace in the United States, due to technological affordability and innovation.23 While some regulations and speci?cations may apply, most commercial, VA, Medicare, and Medicaid services cover telehealth services. Telehealth fee-forservice and/or concierge subscription service models allow for greater frequency and access to niche or boutique treatments that can circumvent insurance for those who are 259 not insured or do not want to use insurance companies.28 Telehealth is being utilized by major employers, with up to 96% of major employers offering telehealth coverage in participating states to reduce health care costs per employee and to provide convenient ondemand care for prevention and treatment of chronic conditions.19 Telehealth has also demonstrated mostly high satisfaction and non-inferiority to faceto-face services.22,23 Sustained relationships with providers and continuity of care can be incorporated in distance care through consistent interactions with providers and clinical team members.5 In addition, integrated care can be enhanced with telehealth, by the incorporation of telehealth services, such as telepsychiatry, into primary care clinical settings.5,22,23 Privacy can be ensured with Health Information Technology for Economic and Clinical Health (HITECH) and Health Insurance Portability and Accountability Act (HIPAA) standards incorporated into telehealth services.23 Hybrid delivery models can offer patients freedom of choice when treatments include a combination of face-to-face treatment and telehealth visits.23 TELEHEALTH IS ALSO PROVIDER-CENTERED CARE Some of the most substantial barriers to telehealth implementation and adoption are the providers themselves.28 In spite of clinician critics and late adopters, there are numerous bene?ts for providers who use telehealth, once they grasp the intricacies of the technological work?ow, laws, billing, and regulations.23 It is important that health care professionals understand that telehealth is a technological tool for facilitating the provision of quality care standards.4,29 Providers have a personal obligation and accountability to ensure that they are competent to use telehealth.4 Conversely, it is the provider’s responsibility to determine if telehealth is ethical for a certain patient, condition, and situation.4 Copyright © 2019 Wolters Kluwer Health, Inc. 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