It should be noted that business practices affect patient-family-centered care within healthcare institutions dramatically. When organizations ensure that patient-provider communication is effective, clients take an active part in the process of care to be as autonomous as possible; this leads to increased loyalty. Regulatory requirement is necessary to ensure that the process of care meets specific quality criteria and that an institution has gone through the accreditation (Roussel et al., 2016).
This implies that the organization meets certain safety requirements, and patients receive services in the amount recommended for their individual case. In its turn, reimbursement is equally important for patient-centered care. If a healthcare organization does not deliver quality care, its reimbursement can be decreased, and its reputation will be jeopardized.
Business Practices, Regulatory Requirements, and Reimbursement and Their Impact on Patient-and Family-Centered Care
The need for modeling business practices arises when solving a variety of problems related to managing a medical institution (Roussel et al., 2016). This includes the reengineering of business processes in order to optimize the processes, the introduction of a quality management system, the preparation to and receipt of quality management certificates, and so on. Moreover, business processes affect the patient-centeredness of the institution in the development of concepts and terms of reference for the construction of medical information systems.
It is important to note that performance management in healthcare remains focused on patient outcomes, rather than on the treatment process. While the outcome of patient care remains a key objective of the provision of medical services, it is necessary to refocus the clinical effect on the process of providing services by which morbidity and mortality statistics can be improved. At present, systems thinking and business process management have become industry management philosophies (Roussel et al., 2016). The healthcare industry is one of the fastest-growing industries, but it still has a low level of maturity in terms of modeling business practices, which inevitably affects institutions.
Regulatory requirements are of great importance to the field of health care and patient-oriented nature of services. Compliance with the uniform requirements for the processes of medical organizations of various profiles and types of activities is ensured through the accreditation received from such regulatory bodies as the Joint Commission and the Center for Medicare and Medicaid Services. Passed accreditation is evidence of the highest quality of medical care, patient safety, the use of the correct methods of treatment and management in a medical institution (Roussel et al., 2016).
The presence of standards allows formulating national requirements for quality management in medical organizations so that they can be competitive. In such organizations, the attitude towards people who receive medical services is changing.
Unified approaches to ensuring the quality of medical care make it possible to unify the requirements for medical organizations on the part of control and oversight bodies. The main directions relate to ensuring the quality and safety of medical activities. They include the organization of medical care based on evidence from evidence-based medicine, compliance with treatment protocols. In addition, the requirements include ensuring drug safety, quality control, and safe handling of medical devices. Surgical safety involves the prevention of risks associated with surgical interventions.
Environmental safety in a medical organization requires institutions to comply with all requirements in the field of patient care, the prevention of pressure ulcers and falls, and the prevention of infections associated with the provision of medical care. Moreover, the requirements ensure continuity of care (Roussel et al., 2016). This involves the transfer of clinical responsibility for the patient, the organization of transfer of patients within one medical organization and transfer to other medical institutions, the organization of emergency care in a hospital.
For each of the main areas, indicators have been identified that are both targets for the daily work of a medical organization and criteria for their assessment. In practical implementation, these areas can be adapted, taking into account the specifics and characteristics of a healthcare organization (Roussel et al., 2016). In addition to qualitative indicators, institutions suggest compliance with quantitative indicators that can be used to form a system for monitoring the quality and safety of medical activities in a medical organization.
In the USA, patient-centered care has a large impact on reimbursement due to the fact that in the private healthcare model, more than 50% of the funding comes from private funds. Funds are accumulated in private commercial insurance funds, after which they go to medical institutions. Service management is decentralized and carried out by a large number of organizations of various ownership forms and levels. In the majority of cases, reimbursable medical services and technology are provided through private insurance plans (Roussel et al., 2016).
The state determines compensation lists only within the framework of a limited number of state programs. The market for medical services and private health insurance plays a dominant role, and the role of the state is limited. Most medical services are provided by private organizations and family doctors. Due to the presence of a large number of private insurance companies, the level of reimbursement in the medical services market is very high. This positively affects the quality of care but only for the financially well-off part of the population.
In addition, the state controls the admission and access of medical technologies to the market, the activities of insurance companies, and protects competition. The issues of ensuring the quality of medical services are resolved through licensing and accreditation of medical institutions and doctors, which are in the hands of professional medical organizations. In the United States, therefore, state guarantees in the field of medical care extend only to a limited circle of citizens, and access to health services is fragmented.
Management of financing by health care facilities and private practitioners is primarily in the hands of private insurance companies (Roussel et al., 2016). The state manages the allocation of resources through special programs for vulnerable population groups. For this reason, studies such as the Hospital Consumer Assessment of Healthcare Providers and Systems survey are important since their results allow studying patient satisfaction. In cases where customers are not satisfied with the level and quality of care, this directly affects reimbursement.
Patient-and Family-Centered Care Organizational Self-Assessment Tool
Setting for Assessment
The setting considered in the assessment is Mayo Clinic, with headquarters in Rochester. It is an academic medical center, which employs 62,900 employees qualified at different healthcare fields and areas of practice (Mayo Clinic, n.d.). It provides diverse services but is particularly known for cancer therapies, cardiological services, and programs for treating the disorders of the endocrine system. The facilities include emergency department, surgery rooms, various suites, and laboratories. The clinic serves patients with various backgrounds and provides services to individuals covered by different types of insurance.
Strengths and Weaknesses
Mayo Clinic has scored quite high for all the domains listed in the assessment tool. In terms of Leadership/Operations, it ensures the staff has opportunities to grow and develop. Various events are organized on a yearly basis; the clinic makes sure the clients are handled in a safety-conscious work environment in which specialists hold security as their top priority (Mayo Clinic, n.d.). In terms of Mission, Vision, Values, the clinic has outlined its principles in the code of ethics and other crucial documents available for the patients. The Advisors’ domain has been evaluated quite high as well due to the fact that staff partakes in various boards and councils.
Quality improvement is another area that meets high standards – Mayo Clinic has implemented various practices that are yet no observed in some other institutions (Roussel et al., 2016). For instance, care providers exchange information at the end of the shift in the presence of the client. Personnel, Environment and Design, Information/Education criteria have been evaluated highly since the clinic uses patient satisfaction surveys, and the environment is quite contributive to patient and their family engagement.
In terms of personnel, the specific strengths are related to the fact that the clinic facilitates effective collaboration between physicians, patients, and their families via policy and performance appraisal systems in place. The environment is organized in a way that allows patients to participate in clinical design projects while ensuring that specialists are engaged in interdisciplinary collaboration. Patients have full access to resource rooms, and they serve as educators for interdisciplinary teams and personnel.
Diversity & Disparities, Charting and Documentation, Care Support, and Care domains are also met due to the fact that the organization offers multilingual support to patients. It also makes records available for patients, and patients and their families take part in the process of care accompanied by informational and educational support. However, the main areas for improvement are related to the inclusion of family members – the clinic needs to engage families in rounds and change of shift activities (Roussel et al., 2016).
Although families are active members of the care team and can stay with the patient, they cannot join change of shift reports as needed. When compliance is bilateral, it involves actions by the healthcare team, to which members of the family respond from the position of conscious cooperation (Roussel et al., 2016). Family involvement is considered the central element of care in a patient-centered approach. According to this model, the family and any specialist who provides medical care to the patient are equal partners.
Family members are invited to actively participate in decision-making, planning, and implementing assistance to the extent possible for them. It is assumed that this concept of medical care is successful if it focuses on the family as a whole, and not on its individual members, and perceives all family members as recipients of care. If families are included in the discussion of change of shift reports, parameters of the psychological state, physical health, and attitudes in patients who were assisted through a patient-centered approach will result in a higher level of general well-being, stress tolerance, and willingness to interact with medical staff.
Area of Improvement
As discussed above, the main area of improvement is the inclusion of families into various aspects of care, and Lippitt’s change theory will be applied to address this need. The clinic’s policy needs to be changed so as to engage family members in the change of shift reports. The core of the strategy will center around the introduction of a multidisciplinary team that will consist of representatives of various areas of practice (nurses, physicians, and so on).
Lippitt proposed a model in which the phases of the organizational crisis are distinguished, such as shock, retreat, recognition, adaptation, and change. The steps involve directed movement, starting from the stage of categorical denial and successively moving to the stage of acceptance or implementation of change as such. In the situation of organizational changes in the clinic, the final result that the organization should come to is not unambiguous and inevitable. In this situation, at the stage of adaptation, the goals of change can be adjusted (Wieck et al., 2010).
Multidisciplinary Team and Its Actions
- The functional team will include nurses, hospital managers and invited specialists (educators) that will be providing suggestions based on their observations and will eventually come up with a plan on how to address the issue (Sullivan, 2017). Managers and staff should discuss what processes relatives can be included in, and in which only professional assistance is needed.
- Staff member, including doctors and nurses, will be held accountable for suggesting changes applicable to different areas to see how families can be included in the process of care more (Wieck et al., 2010).
- Educators will develop a necessary training program to prepare the staff and materials that will be provided to families to ensure their awareness about all the necessary processes in patient care.
- Educators will also organize the training for doctors and nurses about specific communication with patients and their families in new conditions.
- Managers must create conditions for implementing changes.
- Once the vertebrae of steps has been developed, the team will need to educate the remaining staff and do a clinic-wide policy rollout.
- The hospital administration should provide the necessary funding and monitor the success of the process. To evaluate the effectiveness, patient outcomes will be measured, and a client satisfaction survey will be conducted. In particular, sections from the Hospital Consumer Assessment of Healthcare Providers and Systems survey will be adapted to evaluate the effectiveness of the solution.
Since Mayo Clinics is a primary care medical organization that makes first contact with the population, it can be viewed from different angles: as an autonomous and independent entity in the healthcare system and as the first stage of medical care for a wider range of healthcare resources(Wieck et al., 2010).
In this regard, the author of the paper offers an alternative solution – the cooperation of various specialists in the field of health, i.e. creation of a multidisciplinary team, a group of professionals who are united by resolving one healthcare problem on mutually agreed principles. Such a team will include a general practitioner, an expert doctor, a specialist with a narrow scope of practice. Nurses will be as key members of the team since they will be complementing the care delivered by their colleagues. They will be iterating the change of shift report details with families on behalf of the team.
As previously indicated, the multidisciplinary team will include physicians, nurses, educators, managers, and situationally patients’ families. Since the hospital staff already work together for a certain time, changes in their communication are not expected. They will need to continue to meet, deliberate, and share experiences. Communication with educators involves business communication, which will be ensured by the professionalism of the parties. The most challenging task will be to extending communication between medical personnel and relatives. Here they need to show patience, a sense of tact, compassion, and sympathy, accurately and correctly answer all questions asked
Relatives of the diseased person represent a valuable source of information that can affect the diagnosis and treatment of the patient. Thus, the hospital must provide conditions for the inclusion of the family in the process during such stages of the nursing process as assessment, diagnostics, planning, and evaluation. The most effective tool at this stage will be open discussions. Medical staff will need to improve their patient communication skills to prevent misunderstandings.
The inclusion of relatives in the implementation stage causes the most difficulties. Some processes that require professional skills can only be performed by medical personnel. However, the help that relatives can provide will positively affect the patient’s morale by accelerating his or her recovery. According to this, it is necessary to precisely determine the tasks that relatives can perform not to harm the patient. At the same time, their participation should be voluntary desire of patients and their families, not forced.
Possible consequences for the hospital include speeding up the treatment process thanks to the patient’s moral support and saving nurses’ time. Negative effects may include feelings of a burden on relatives and increased anxiety. Moreover, additional financial costs are needed to ensure the presence of families in the hospital.
The implementation of the strategy will have moderate financial implications. In particular, the multidisciplinary team will need to go through training and then start working as a functional unit. The repercussions will imply that the interdisciplinary team will need to receive financial incentives and be provided with resources to make a group decision. Thus, the necessary financial implications will include the payment of invited specialists, funding for operating costs, which are educational materials for staff and families, conducting surveys and others. Implications are also expected in the form of motivation bonuses for employees, for which the work of the new multidisciplinary team will be an addition to current obligations.
Cultural Diversity, Leadership, and Self-Assessment within the Team
Cultural diversity within the team will be particularly important in changing the policy. This is due to the fact that the Mayo Clinic serves the needs of various population groups, and a multi-ethnic team will ensure that the updated process is inclusive and meets the various needs of diverse patients. Cultural competence within the team will be especially important and will contribute to the intensification of intercultural interactions.
This implies the study of the team’s ideas about the optimal social distance and the prospects of joining an intercultural professional group. The formation of social perceptions and stereotypes of cross-cultural compatibility, emotional preferences, and behavioral choices will occur in the work environment, which will allow delivering better quality of care to patients belonging to different cultures.
In terms of leadership styles, the transformational leadership approach will be employed in the process of implementing change (Wieck et al., 2010). It is aimed at ensuring that employees do not only perform their responsibilities but strive to exceed the leadership’s expectations. This requires more advanced methods of influencing staff in addition to the classic approaches. A tool to be used to develop the team’s self-assessment is the Myers-Briggs Type Indicator. It will be helpful in the prevention of conflicts and miscommunication due to the diverse nature of the team.
To address the weakness identified during the assessment, the team will follow the steps of the nursing process. Higher-level specialists will supervise decision-making; nurses will have assistant roles; the supervisors will provide additional support and oversee the process. To communicate the strategy and outcomes to the clinic, the team will do weekly scrums and educational meetings (Wieck et al., 2010). The team will do patient and family education on the process to achieve greater awareness and make the process patient-centric.
Mayo Clinic. (n.d.). About Mayo Clinic. Mayoclinic. Web.
Roussel, L., Thomas, P., & Harris, J. (2016). Management and leadership for nurse administrators (7th ed.). Jones and Bartlett Learning.
Sullivan, E. (2017). Effective leadership and management in nursing (9th ed.). Prentice Hall.
Wieck, L. K., Dois, J., & Landrum, P. (2010). Retention priorities for the intergenerational nurse workforce. Nursing Forum, 45(1), 7-17. Web.