Patient-Care Delivery System: Implications of Technology Integration - Research Paper Example

? Patient-Care Delivery System: Implications of Technology Integration An effective way of increasing the efficiency of record-keeping for patients within a hospital would be the creation of a computer-based information system that is accessible to all nurse and hospital staff. However the implementation could meet several setbacks such as improperly-computed cost-benefit analyses, lack of enthusiasm and open-mindedness from the management or the subordinates, as well as incorrect information dissemination to users. In order to facilitate such changes, problems encountered by most staff during duty must also be put in to consideration, as well as the long-term benefits of using such system. Not only would this reduce errors and problems within the hospital, it could also help in giving better patient care for years to come. Patient-Care Delivery System: Implications of Technology Integration The success of the restructuring of a hospital’s nursing organization relies on the mindset of all members, from the management down to the nurses in duty (Kelly, 2011). Each must think of themselves as a leader who is accountable for whatever service they would give to their patients. Also, each member of the organization must be able to act and decide based on the hospital’s vision and purposes while ensuring that the patient is at the top of their priorities, and being creative and flexible in solving problems along the way (Kelly, 2011). If the whole hospital setting is able to achieve this mindset, it can be assured that they can perform high levels of patient-care delivery each and every time. This is the premise of giving high levels of services to patients. The promulgation of a successful patient-care delivery process in the nursing settings can be achieved through the proper coordination of different resources and clinical processes that would bring the best services of the hospital to the patient (Kelly, 2011). In order to facilitate an effective process, several components must be able to jive with one another, such as the assessment of the hospital’s internal and external environment, the formation of the best strategy for implementation, and preparing the needed annual operating costs to finance the process as a whole (Kelly, 2011). Examples would include the upgrade of the record system being used by the hospital, and the concurrent trainings of all staff in using the new system. Not only must the hospital’s facilities and organization must be arranged, but the medical and nursing teams’ mindset as well, so as to align their objectives with the organization (McGillis, Doran, & Pink, 2004). Their core competencies, much like the facilities must also be upgraded regularly in order for them to deliver state-of-the-art services to patients (Burchell, Smith, & Piland, 2002). If the overall changes implemented in the hospital’s organization and its members’ workflow function seamlessly with one another, this would give the hospital its image of high-performance, giving itself an edge over the competition (Rowland & Rowland, 1997). History of the Patient-Care Delivery System Like most hospital settings in other countries around the globe, initially the first settlers in the United States used crude folk remedies to cure epidemics and other disorders (Green & Bowie, 2010). However, the advancement of medicine also gave rise to improved delivery of patient care. The increase in the populations also gave rise to the establishment of larger hospitals to accommodate more patients, and the subsequent demand for competent medical personnel. Health insurances were also founded to assist patients in shouldering hospitalization expenses. To assure that all hospitals are able to give proper treatment, the government issued standards that all hospitals must comply with (Green & Bowie, 2010). Also, the establishment of non-profit hospitals made healthcare accessible to those who may not be able to pay due to the lack of health insurance or money. While the progress of the healthcare system was rather slow in the previous two hundred years, the arrival of the scientific age made the evolution of healthcare services faster (Cohen & Cesta, 2005). Changes in the demographic, economic status, and societal trends also affected the kind of services that hospitals offer. In order for hospitals to keep being able to provide proper patient care for all patients, different models of nursing care were created. Among the models that were developed are the following: Case method – complete care is given by a single nurse to a single patient, having full responsibilities in this task. Deemed rather inefficient since only one nurse provides direct care for a single patient (Cohen & Cesta, 2005); Total patient care method – similar to case method but several patients are under a single nurse during the shift. Even more inefficient in the hospital settings due to high level of hours on duty in delivering care to numerous patients. Works best in specialized settings such as hospice care (Kelly, 2011); Functional method - uses a division of labor approach by implementing specific tasks to specific personnel. While regarded as a highly-efficient system, sole reliance on assigned tasks and the lack of providing continuous care causes frustrations on the nurse and patient, respectively (Cohen & Cesta, 2005); Team nursing – assigns staff to teams responsible for a group of patients. A lead nurse (RN) would be responsible in the delegation of tasks to the team members as well as their supervision. Possible problems can stem from lack of complex communication between members and the lead nurse, which in turn could contribute to the dissatisfaction of patients (Kelly, 2011); Primary nursing – a model that clearly delineates the responsibility and accountability of the RN as the primary care provider for patients. The primary nurse would be making a care-giving plan to the patients assigned, which would also be used by other nurses should the primary nurse be on leave. High levels of skills would be needed by the primary nurse to create effective plans that can be easily followed-through by others in case of his/her absence (Cohen & Cesta, 2005); Patient-centered care – designed to focus on patient rather than staff needs. Care teams are established based on proximity to patients, and the whole group may also be composed of interdisciplinary members to ensure that the patients’ needs are taken care of by the right staff (Kelly, 2011). With the different methods and models of providing patient-care, the hospital must not only be able to come up with the most efficient model but also to utilize the number of staff available for a successful implementation. Problems than can be Encountered during Organizational Restructuring While the restructuring of an organization in the nursing settings is expected to bring positive results, there are also several factors that could pose problems to the implementation of such a wide reorganization. For one, when the main philosophy of the hospital shifts from giving excellent services to their patients into just focusing on the hospital’s business side (Burchell, et. al, 2002). Still another problem would be the lack of team-based skills among the medical professionals, especially now that there is an increase in the need for teams that are interdisciplinary in nature (Royeen, Jensen, & Harvan, 2011). Also, the complacency of the members of the management committee to their tried and tested methods could prevent the advancement of the hospital’s services (Tucker & Edmondson, 2003). Lastly is the need for the competence of the staff in using a computerized information system not just for managing the records of the patients but also to recover well and adding any missing data to these records (Paustian, Slovensky, & Kennedy, 2001). In order to focus on a specific problem, this paper will focus on the possible problems that can be encountered in the implementation of information retrieval systems within the nursing settings. Statement of the Problem A main problem that is frequently encountered during the upgrade of the patients’ information retrieval system would be the successful implementation of a computer-based record filing program. The usual conflicts would come from the expenses that can be deduced during the project’s proposal, the inability of some staff to use the system (e.g. those without much exposure to the use of computers), as well as the maintenance costs of operating such a system (Green & Bowie, 2010). Other barriers to the implementation of informatics in the field of nursing is the need of some higher-management staff to oversee the implementation of the system properly, which could prove difficult if most of them are not even familiar with the possible costs and benefits that such an upgrade would provide (Amatayakul & Lazarus, 2005). By not being able to relay to the subordinates the numerous benefits of using a computer-aided patient record system for example, many would just resort to paper documents instead, which have a higher chance of being compromised or even getting lost (Green & Bowie, 2010). Thus the problems to be explored in this paper are the following: Main Problem: How to successfully implement a computer and network-based information system in the nursing settings. Specific Problems: How to disseminate information to all nurses and other hospital staff regarding the functions and use of the computer-based information system. Making the system prompt and give reliable access to all users that need the electronic information. Implementing the said system within reasonable budget, as well as continuing the maintenance and upgrading costs. Scope of the Problem In order to further specify the focus of this paper, the scope of the problem would be focusing on the front lines of the patient-care delivery system, which are the nurses. Since they are the direct link between the patient and the hospital’s organization, nurses would be able to pinpoint problems as well as errors in the workflow (Blancett & Flarey, 1995). These problems and errors encountered would provide data needed that could help creating the solutions (Tucker & Edmondson, 2003). While most errors would be committed on the individual level and may not affect numerous staff, problems within the organizational workflow could create even more frustration within the hospital staff due to the larger extent that gets affected, such as problems outside the jurisdiction of nurses (Tucker & Edmondson, 2003). Thus, by keeping the limitation to nurses the changes in the organizational workflow need not to be abrupt, and it can be gradually implemented (Kremsdorf, 2003). This can be easier to manage rather than doing one major revamp, which could be stressful to the majority of the organization (Blancett & Flarey, 1995). Solutions and Limitations The advantage of interviewing nurses is that the problems that they encounter in a daily basis as well as other possible solutions to problems can be compiled and be used for the development of the informatics that is planned to be implemented (Blancett & Flarey, 1995). An additional advantage for this is that by interviewing nurses in different fields, an even more accurate list of problems can be generated, thus making sure that the new system to be implemented would be unbiased in giving solutions. Also, interviews could also give a view of the current solutions being used, as well as to come up with either short-term or long-term solutions, and let the management choose which to implement (Tucker & Edmondson, 2003). Identification of short-term solutions to problems could assist in the discovery of underlying problems within the old organizational system, such as the lack of preventing the recurrence of similar problems within the nursing staff (Tucker & Edmondson, 2003). If communication between the staff does not occur, or if the problems being encountered are not being recorded, small problems could keep recurring and the nurses would keep on shouldering time and costs to solve them. This could in turn reduce their productivity and efficiency in delivering care to patients (Tucker & Edmondson, 2003). A possible solution for this would be the use of system applications such as a database for small recurring problems, as well as a decision-making and support systems to ensure that all staff needing solutions would be informed. Another problem that is mostly encountered by nurses is the incorrect or incomplete information being transferred regarding patients and their medications. This could result to incorrect diagnoses, medicine dosages and even unnecessary procedures done to the patient (Tucker & Edmondson, 2003). Such problems would not only cost money and time but also the credibility of the hospital and its organization itself. However, by utilizing an electronic health record (e.g. digital medical record) not only would inconsistencies would be minimized, but also all nursing staff attending to the patient would be able to update the records as to what procedures were made, medicines administered, etc. all in real-time (Amatayakul & Lazarus, 2005). Last of the problems most encountered is the upkeep of patient files in order. Keeping patient files often means having to use numerous filing cabinets as well as storing them in paper. Not only would the spaces used for keeping the files be space-consuming, but also paper is likely to disintegrate as time progresses, making copy retrieval even harder. Also, hard copies must be made at all times, and there would be times that a single transaction may have either numerous copies or none at all. Such inconsistencies may be solved through the use of electronic health records (EHR's) (Shi & Singh, 2009). By scanning or using a program in keeping the records of the patients in a network, compromising of sensitive data can be minimized, and if copies are needed it would be much faster to create as well as store. Possible setbacks would include the compliance to the Health Insurance Portability and Accountability Act (HIPAA) guidelines, as well as the security of such networks. Thus it is also important that the EHR would be initially tested to several patients first before going full-scale, in order to save money as well as to redesign the program if problems are to be encountered during the trial run (Amatayakul & Lazarus, 2005). In order for the successful implementation of the computer-based electronic system within hospital settings, limitations must also be taken into account. One is the size of the hospital, second is the users of the program, and third is the kind of system needed in the facility. Since the cost of software development and installation is rather expensive, smaller hospitals may opt to upgrade their systems one application at a time, to make sure that the cost would be more manageable and the return on investment would be earned at an earlier time (Green & Bowie, 2010). Larger hospitals can manage to have more applications if they have enough revenue to support more systems. Next, the programs and the users must also be put into consideration, as well as to what problem within the facility must be solved. For example, if the problem is more on patient record filing, then the program to be installed should be an EHR, and if schedules of administering medicine needs improvement, then a digital medical record must be installed (Amatayakul & Lazarus, 2005). Conclusions and Recommendations for Further Research Implementation of a computer-based information system within the nursing settings would need the enthusiasm, open-mindedness as well as dedication of the organization’s members. Problems within the nursing staff level can be used to identify what kind of program would be implemented within the organization. Also, budget constraints must be studied in implementation so as not to purchase an expensive system that might jeopardize the operating expenses of the hospital. In totality, to be able to provide quality patient-care, not only must the upgrade of the information system in the nursing organization necessary, but also the members and the staff that would be using the system must also be properly trained to access the full potential of the system in making workflow more efficient. Suggested recommendations for further research regarding this topic would be the survey of the number of hospitals within a given location that utilize such systems. In relation to this, a survey of the different information systems being used in most hospitals may also be conducted in order to find out the percentage of hospitals that use electronic systems for assistance, in several locations. Lastly, making a survey as to the demographics of hospitals that utilize electronic records can be useful in establishing the profiles of hospitals that are using or not using electronic systems in their line of work. References Amatayakul, M., & Lazarus, S. (2005). Electronic health records: transforming your medical practice. Englewood, CO: Medical Group Management Assn. Blancett, S., & Flarey, D. (1995). Reengineering nursing and health care: the handbook for organizational transformation. Gaithersburg, MD: Aspen Publishers, Inc. Burchell, R., Smith, H., & Piland, N. (2002). Reinventing medical practice: care delivery that satisfies doctors, patients, and the bottom line. Englewood, CO: Medical Group Management Association. Cohen, E., & Cesta, T. (2005). Nursing case management: from essentials to advanced practice applications. St. Louis, MO: Elsevier Health Sciences. Green, M., & Bowie, M. (2010). Essentials of health information management: principles and practices. Belmont, CA: Cengage Learning. Kelly, P. (2011). Nursing leadership & management. Clifton Park, NY: Delmar, Cengage Learning. Kremsdorf, R. (2003). Using innovation technology to enhance patient care delivery. Nursing Outlook, 51 (3): S16-30. McGillis, L., Doran, D., & Pink, G. (2004). Nurse staffing models, nursing hours, and patient safety outcomes. Journal of Nursing Administration, 31 (4): 41-44. Paustian, P., Slovensky, D., & Kennedy, J. (2001). Information system failures in health care organizations: case study of a root cause analysis. Managing Information Technology in a Global Environment: Information Resources Management Association. International Conference, May 20-23, 2011 (pp. 366-368). Toronto: Idea Group Publishing. Rowland, R., & Rowland, B. (1997). Nursing administration handbook. Gaithersburg, MD: Aspen Publishers, Inc. Royeen, C., Jensen, G., & Harvan, R. (2011). Leadership in interprofessional health education and practice. Sudbury, MA: Jones & Bartlett Publishers, LLC. Shi, L., & Singh, D. (2009). Essentials of the u.s. health care system. Sudbury, MA: Jones & Bartlett Publishers, LLC. Tucker, A., & Edmondson, A. (2003). Why hospitals don't learn from failures: organizational and psychological dynamics that inhibit system change. 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