DU NUR 318 Leadership for Quality Care & Patient Safety Nursing Leadership Discussion

DU NUR 318 Leadership for Quality Care & Patient Safety Nursing Leadership Discussion ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON DU NUR 318 Leadership for Quality Care & Patient Safety Nursing Leadership Discussion 1- Analyze and critique this article in relation to your role as a leader or nursing leadership within your organization. The annotated bibliography should be brief and concise, two to three paragraphs double spaced. Analyzed article completely and accurately, showing outstanding understanding of the article with identification of issues, or concerns related to nursing leadership and communication challenges for 21st century nurse leaders. DU NUR 318 Leadership for Quality Care & Patient Safety Nursing Leadership Discussion 2-Information is presented in a logical and interesting sequence which audience can follow. Structured formal writing, flows well, basic transitions are used; Article summarized well, clear and concise, contains no grammatical, mechanical, or APA errors 3- Develop one key question from the article you would like to present for the discussion attachment_1 Reimagine Health Care Leadership, Challenges and Opportunities in the 21st Century Esther Lee, MNP, MBA, RN, CEHL, JoAnn Daugherty, PhD, RN, CNL, Thomas Hamelin, MBA, DNP, RN, NEA-BC Purpose: This paper spotlights human capital management, digital technology, and costs control as issues that healthcare leaders will face in redesigning the health care ecosystem in the 21st century. Design: The paper was designed to highlight the attributes that make effective leaders. It addresses how nursing leadership can take a lead to redesign the 21st Century health care system, supported by case examples. Methods: An expansive literature review was done using MEDLINE, SAGE, Google Scholar, and University of California San Diego Library Catalogs. The selections criteria include recent publications in English within and outside the healthcare industry. Findings: Health leadership is viewed as paramount to productivity, capacity and meeting new challenges. Conclusions: Effective nursing leadership in a healthcare organization correlates with staff job satisfaction, retention, turnover and quality of care. Nursing leadership development must be supported by appropriate level of educational preparedness, and requisite set of competencies and skills. Keywords: health care leadership, digital technology, mHealth, human capital management, financial management. Ó 2018 by American Society of PeriAnesthesia Nurses OBJECTIVES—1. DESCRIBE LEADERSHIP styles commonly used by 21st century nursing leaders; 2. Discuss the economic and organizational challenges faced by nursing leaders in 21st century health care; 3. Describe two strategies health systems can use to redesign practice models Esther Lee, MNP, MBA, RN, CEHL, Perianesthesia Services, UC San Diego Health, San Diego, CA; JoAnn Daugherty, PhD, RN, CNL, Perianesthesia Services, UC San Diego Health, San Diego, CA, and School of Nursing, California State University, San Marcos, CA; and Thomas Hamelin, MBA, DNP, RN, NEA-BC, Operations SAMMIS and Perioperative Services and Trauma/ Burn Programs of the UC San Diego Health, San Diego, CA. Conflict of interest: None to report. Address correspondence to Esther Lee, UC San Diego Health, 200 West Arbor Drive, #8708, San Diego, CA 92103-8708; e-mail address: [email protected] Ó 2018 by American Society of PeriAnesthesia Nurses 1089-9472/$36.00 https://doi.org/10.1016/j.jopan.2017.11.007 Journal of PeriAnesthesia Nursing, Vol 34, No 1 (February), 2019: pp 27-38 to offset declining reimbursement and increased operating expenses. Changing demographics, global and regional health care human resource shortages,1-3 digital technologies, limited job-related resources, and economic pressure have impacted health care delivery. These factors affect the relationship among health providers, payers, and health consumers. Meeting these challenges requires health care leaders to reimagine and innovate new service models that may deliver the best affordable care efficiently, reliably, and cost-effectively. Digital technologies4-6 promise to mitigate some of the challenges in affordable care delivery, giving more control and power to patients for self-care but they are countered by risks such as privacy and how to best collect, process, and understand the vast amount of health data generated by digital technologies.7 Health leaders in many developed 27 28 economies with a multicultural population also face the challenges of harnessing the best in their human capital resources to their competitive advantages.8,9 Many developed economies are facing a demographic trend characterized by a growing aging population accompanied by increasing prevalence of chronic diseases.7 With rising health care costs, the major challenge to the health care leadership is to deliver the best and affordable care collaboratively while addressing the escalating costs of care. DU NUR 318 Leadership for Quality Care & Patient Safety Nursing Leadership Discussion This article addresses some of the economic, human resource, and technological challenges facing health care leaders in many provider organizations. LEE, DAUGHERTY, AND HAMELIN lowers to strive for excellence, awakens their latent potential through expression of values and believes and the leader’s goals. In contrast, a transactional leader motivates followers with rewards for their self-interests in exchange for their effort and services.10 This leadership style fits into many settings but may not inspire innovation.14,15 Health Care Leadership Alloubani et al16 indicate that international interest in leadership is evident in both private and public health care organizations, which view leadership as central to organizational productivity, capacity, and meeting new challenges. Leadership Stroh et al10 explain that the roles of managers and leaders are radically different. In addition to being able to achieve the organization’s goals, leadership is defined by two characteristics: the situation and the followers resulting in a reciprocal interdependent relationship.10,11 Essential attributes of a leader have been described as knowing oneself, being able to communicate one’s vision, building trust among colleagues, and taking action to realize one’s potential.12,13 Bennis and Thomas13 argue that extraordinary leaders are the ones with the ability to overcome adversity, learn from the most challenging circumstances, and emerge stronger and more committed to what matters to them the most. They contend that great leaders are defined by four distinct characteristics: ‘‘the ability to engage others in shared meaning, a distinctive and compelling voice, a sense of integrity and a strong set of values, an adaptive capacity as defined by the skills to grasp context and hardiness.’’13 Transformational and Transactional Leaders Two commonly popular types of leadership are transformational and transactional leaders. Aarons14 contends that a leader may find it necessary to combine both transformational and transactional leadership styles to be effective. A transformational leader functions well in a close supervisory relationship and is more concerned with ideas and vision than processes. This leadership style inspires fol- Numerous studies and systematic reviews of the literature have identified transformational leadership as crucial in fostering employee creativity, successful conflict resolution, improved staff satisfaction, lower medication errors, decreased patient fall rates, lower infection rates, and lower mortality rates.17-20 The Magnet Recognition Program, the gold standard of nursing care excellence administered by the American Nurses Credentialing Center of the American Nurses Association, has identified transformational leadership as one of five essential attributes in its Magnet Model.21,22 A survey of 116 hospital Chief Executive Officers in Iowa shows that transformational leadership correlates highly with performance, effectiveness, and satisfaction.18 The best performing hospitals have widely distributed leadership, empowerment, and broad staff engagement in decisionmaking processes. Job satisfaction and opportunities to participate in the decision making have been shown to associate with high levels of job performance and strong identification with the organization.23 Effective nurse leaders bring cohesion to the team; are flexible and empowering; and possess a high degree of emotional intelligence, ethical standards, and promote high quality performance.DU NUR 318 Leadership for Quality Care & Patient Safety Nursing Leadership Discussion Gilmartin and D’Aunno24 state a strong association of effective nurse managers with job satisfaction, retention, and turnover of staff. Wong et al25 have discovered a link of staff well-being and job satisfaction with quality of care as measured by mortality rate and medical errors. HEALTH CARE LEADERSHIP In our own experience, the lead author’s perianesthesia division is guided by the shared governance model. Staff are empowered with a high degree of autonomy within an operating framework and serve on numerous unit-based and hospital-wide committees. The nursing team is exemplified by cohesion and teamwork. Staff participate in team building with off-site meetings and social outings. They share knowledge, provide mutual support and assistance as circumstances require. They celebrate success for their achievements by having employee of the quarter awards in which winners are selected by staff rather than managers. Staff turnover rate has been maintained consistently at 2%. In addition to staff satisfaction, Wong et al25 identified staff satisfaction is linked to quality care and patient satisfaction. In our institution, we have found patient satisfaction survey results at discharge averages 95% of high satisfaction year after year. Exit survey response may be summed up as ‘‘extremely satisfied and will recommend the health system to others.’’ Leading Change–Nursing Education and Skills The Institute of Medicine states that to play a critical role in transforming the health care system, ‘‘the nursing profession must produce leaders throughout the system, from bedside to the boardroom.’’26, p07 Nurses must be equipped with the appropriate set of competencies and education to be full partners with physicians and other health care professionals to meet the challenges of a dynamic, rapid changing, and sometimes chaotic health care environment of the 21st century.26,27 The report, the Future of Nursing, Leading Change, Advancing Health,26 advocates nurses need to develop two sets of competencies to be full partners and effective leaders. These competencies include a common set that serves as the foundation to position oneself for any leadership opportunities and another set tailored to a specific context, time, and place. Huston27 corroborates that nurse leaders in the 21st century health care environment must be equipped with the appropriate set of competencies and education to be effective. These attributes include a global mindset regarding health care and professional nursing issues; a working knowledge of technology that facilitates portability, mobility, inoperability, 29 and interactions; expert decision-making skills anchored by empirical science; prioritizing quality and safety; being politically astute and understand the intervening influence of the political processes; a highly developed collaborative and team building skills; an ability to balance authenticity and performance expectations; and being forward looking and proactive to cope effectively with rapid changes. Slavkin11 maintains that ‘‘achieving health and well-being require leadership at all levels of an organization.’’ Leadership training, development, and support are essential to the present and future success of diverse health care organizations. The authors’ organization provides leadership training at the organizational and divisional level. Frontline employees are provided with leadership and customer service training. In a 1-day off-site experience, the Chief Executive Officer and other senior directors lead the educational sessions in this educational and team building program. This direct connection with senior leadership engenders a positive impact on employee engagement. Leaders in the Perianesthesia division regularly conduct leadership training sessions to groom upcoming leaders and to augment managers and educators in their clinical leadership. DU NUR 318 Leadership for Quality Care & Patient Safety Nursing Leadership Discussion Training sessions include case studies of exemplary leadership and best practices within and outside the health care industry. Leadership candidates are also trained to be reflective and to reference key success factors as benchmarks to their own practices and continuous improvement. Challenges and Opportunities to Health Care Leaders of the 21st Century Changing Demographics and Nursing Shortages Critical factors affecting health care in the 21st century in the developed countries are aging demographics and increased health care consumptions because of the rise in chronic, debilitating, and long-term health conditions. This ‘‘Silver Tsunami’’28 of aging health care consumers is accompanied by an aging health care workforce that mirrors the aging demographics. The World Health Organization informs that the demand for nursing care increases as the world population 30 ages. About 57 countries will experience shortage in such a magnitude as to threaten the delivery of essential nursing care.19,20,29 All Western countries are predicted to experience nursing workforce shortages and shortages are attributed to an aging workforce30: decreasing enrollment in the nursing programs, nursing burn-out, an increase in chronic diseases, and competition from other industries.26 In the United States, the average age of a registered nurse (RN) is 47 years with more than a third between the ages of 50 and 64 years.30,31 A large percentage of RNs in the health care workforce, including about 75% of health care leaders, are projected to retire by 2020.26 Foreign recruitment is no longer able to fill the gap of the shortfall and the ‘‘brain drain’’ (loss of nursing talent) from the source countries adversely impacts equity, access, quality, and cost of health services on a global level. Human Capital Management—Succession Planning Although the human resource issues are not addressed in details in this article, the effect on costs must be noted. With health care being a knowledge intensive industry, the exit of the baby boomer generation from the nursing profession will exact a toll of higher burden of costs in health systems. The imminent loss of a repository of knowledge, skills, and expertise may not be immediately replaced and fulfilled by younger and less experienced RNs, threatening the smooth transition and care delivery. The exodus may result in the deterioration of care, higher negative outcomes, and poor health services.30,32 The application of technology and nursing education reforms to equip nurses with a modern set of knowledge and skills are viewed as strategic to the health care systems, today and the future.15 A study by Titzer and Shirey33 indicated 70% of hospitals do not have a succession plan and 38% of health care succession planning tends to focus on the senior management tier. Key success factors point to the fact that strategic succession planning needs to consider current and future leadership requirements at all levels: identify and groom future leadership talent, retain, promote, and train talent from within and allocate sufficient resources for LEE, DAUGHERTY, AND HAMELIN leadership development to ensure continued organization leadership.34 Knowledge Management Health care organizations are moving away from a physician-patient model to a company-customer model with quality of care being measured by technical and interpersonal care in meeting a patient’s need and expectation.34,35 Organizational performance is measured across functional lines such as finance, organization learning, and human capital management.34 Knowledge is considered a critical resource that provides an organization with its competitive advantage. Knowledge sharing and transfer has demonstrated lower cost of operation, reduced medical errors, improved quality, improved innovation, enhanced team, and organization performance.DU NUR 318 Leadership for Quality Care & Patient Safety Nursing Leadership Discussion 36 Therefore, it is critical for an organization to capture the tacit and explicit knowledge of older and experienced managerial and staff leadership cohorts to create a repository of knowledge database, transforming individual knowledge into organization intellectual asset.36 Wong and Noe37 estimated that an annual loss of about $31.5 billion among the Fortune 500 companies is related to failure to share knowledge. DIGITAL TECHNOLOGY. According to a report by Deloitte Center for Health Solution,38 the health care sector remains a laggard comparing to other industries in using technology with service users. However, with declining cost for evolving digital technology, connected health, also known as technology enabled care is increasingly viewed as an integral part of a solution to the challenges that health care sectors face to deliver effective and integrated care. Available patient data from information generated by the vast computational power associated with digitization of electronic medical record and other information technology (IT) systems should be embedded into operations for informed and actionable decision making and predictive forecasting using integration technology.7 The role of mobile health technology or mHealth includes the use of smartphones, various mobile technologies such as patient monitoring devices, and gaming applications (apps) to support public health and patient care. Currently there are about HEALTH CARE LEADERSHIP 100,000 mHealth apps available on the Apple and Android platforms.39 Health care providers and patients now have mobile apps to manage chronic disease challenges such as dementia, Parkinson’s disease, congestive heart failure, and diabetes.40-42 CASE EXAMPLES. Vidant Health42 started a program in 2002 to remotely monitor 600 to 700 patients with congestive heart failure, diabetes, and high blood pressure. Each patient was provided with a transmission-capable mobile device to measure blood pressure and other vital signs and to send the data via cellular service to Vidant. After the implementation of this care plan, hospital admissions for these patients fell 74% in 2013. At the Boston Children Hospital, patients and families are provided with a tablet to navigate through the path of care. The tablets enable users to access test results of the laboratory, the care plans devised by clinicians and therapists, and inform of discharge criteria. Patients and families can also access the care team to send care-related questions to the providers.41 Avera Health in South Dakota provides telemedicine service (eCare) to 86 hospitals and more than 100 facilities across 600,000 square miles. Its offerings comprise electronic intensive care unit (eICU), eEmergency, ePharmacy, eConsult, and eLong-term care. For example, eICU monitors multiple ICUs at once and helps staffing shortage by identifying staff gaps. Outcomes include improved patient experience, lowered mortality rate, and decreased length of stay. Using telehealth and a remote clinical expert team, eAcute offers 24/7 patient monitoring services to augment in hospital medical and surgical expertise. Annual savings in health care cost attributable to telemedicine are estimated at $143 million.38 IMPLEMENTATION BARRIERS. DU NUR 318 Leadership for Quality Care & Patient Safety Nursing Leadership Discussion Many health care providers remain aloof about using mobile devices and apps owing to insufficient understanding of the risks and benefits.5 A major concern is data security and potential Health Information Technology for Economic and Clinical Health Act and Health Insurance Portability and Accountability Act violations. Many security breaches occur because of employee negligence, theft, or loss of unencrypted devices. Increasingly thieves see health data as more valuable than financial data. There is an increase in ransomware 31 attack of IT systems with potentially damaging outcomes. The cybersecurity industry estimates that the costs to a health care system and its stakeholders of a data breach will amount to about $2.2 million.43 Other barriers include concerns about lack of evidence on cost effectiveness and absence of supporting data; lack of common interoperability standards; and most mHealth apps are too consumer-oriented with limited integration into the medical system.38,41 Reimbursement for telehealth poses another challenge. A comprehensive reimbursement architecture is absent. Not all private payers have systems in place to reimburse telehealth and may deny payment for such service.44 Payment for telehealth varies; Centers for Medicare and Medicaid Services and a few payers only reimburse some telehealth services, including areas related to wellness and behavioral health. Some states permit online clinical visit and ePrescribe, where … . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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