REQUIREMENTS: 150 words min EACH, 1 scholar source (5 or less years) EACH, APA format. 

REQUIREMENTS: 150 words min EACH, 1 scholar source (5 or less years) EACH, APA format.

Post 1:

Two drivers of high performance healthcare system that are always required from the organization (hospital) where I work are quality and costs. With this constant demand for high quality of care, nowadays healthcare services are reimbursed based on HCAHPS and patient satisfaction. HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey is the first national, standardized, publicly reported survey of patients’ perspective of the hospital care that they received (Centers for Medicare and Medicaid Services, September 25, 2014).  Since patient satisfaction is linked to reimbursement, the people in leadership positions are constantly demanding high quality care to be provided to ensure patients are satisfied at the time of the surveys. This can be a problem because there are times we are under staffed which leads to nurse to patient ratio being high. With high nurse to patient ratios the care provided can be affected along with patient satisfaction. Because nurses will not have enough time in a 12 hour shift to tend to every need a patient may have and that will result in the patients becoming upset and dissatisfied. All this will affect the quality driver of high performance in the organization (hospital). Furthermore, there was the introduction of the Deficit Reduction Act of 2005 which created an additional incentive for acute care hospitals to participate in HCAHPS; since July 2007 hospitals subject to the Inpatient Prospective Payment System (IPPS) annual payment update provisions must collect and submit HCAHPS data in order to receive their full IPPS annual payment update (Centers for Medicare and Medicaid Services, September 25, 2014). Therefore, if a hospital receives a low HCAHPS then their reimbursement will be affected. The cost driver can be affected due to the nurses resigning and the expenses involved with training new staff. Nurses are resigning due to the high nurse to patient ratio. In addition, patient dissatisfaction results in low HCAHPS and in turn affects the hospital monetary reimbursement and jeopardizes their attempt to control cost due to nurses leaving the organization looking for a better work ratio.

Post 2:

Access to healthcare is always discussed as one of the top concerns for the overall health of individuals. Millions of people around the world go without appropriate basic healthcare needs or are very limited in access for advanced needs. Cost is very closely in the running for top concerns related to healthcare also. This discussion selects cost and access as the two drivers to apply to my current work situation. Currently I nurse in a rural community emergency room within a critical access hospital which serves many that would normally either remain limited in access for advanced needs or drive extended periods for access elsewhere which inadvertently reduce timely access at the point. There is a presence of concern when legislative efforts aim to increase access and, at the same time, reduce costs! This can easily overburden a rural system which can negatively affect quality. Rural residents, historically, are among America’s most vulnerable populations when it comes to healthcare access (Grant, 2017). About sixty million individuals, within America, live in rural areas, tend to have lower income and have more health problems; this encompasses approximately twenty-three percent of the population (Grant, 2017). Lack of available primary care and specialty services shifts these individuals toward emergency or urgent care facilities for primary care which creates situations where nurses must be able to efficiently adapt to changing patient needs (Pare, Boynton-Sharp, & Peterson, 2017). Nurses in rural settings must be especially adept at continually redirecting their care and skills to adapt to these changing situations and they must do so with minimal support, simply because the support is limited in rural systems (Pare, Boynton-Sharp, & Peterson, 2017).

Critical access hospitals are among some of the most critical access points for our rural residents. Policy changing can easily impact their ability to remain afloat and open for access. They typically maintain thin financial margins and have less ability to shift losses to individuals who are privately insured because the population served is historically uninsured (Grant, 2017). Interestingly, there is a correlation between lack of access and increased overall healthcare costs. As costs for caring for the uninsured and those with less access increases, some of the cost burden is shifted toward increasing costs for those insured (Tongue, 2012). Economic impacts for insurers, employers and individuals increase thus forcing increased cost or reduction of coverage and, ultimately, reports of unmet medical needs by those who are insured (Tongue, 2012). As shifts are made to cover costs it is causing costs to rise and benefits to reduce or cease, exacerbating the uninsured problem and increasing the lack of access. Each of the drivers mentioned in the discussion are almost equally important and as you delve into each it becomes more apparent how our “multifaceted, convoluted and interrelated” (Chamberlain College of Nursing, 2018) healthcare system can easily be impacted by a single policy change affecting all other aspects of the system! It seems almost impossible to develop an approach to solve all issues collectively and concurrently.

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