Part Two: The Major Players in Health Care Service

Chap 3. Healthcare service delivery: providers

林育秀, Ph.D.2021

Healey, B. J. (2015). Introduction to health care services:

foundations and challenges. Jossey-Bass, A Willey Brand.

Primary care providers

▪ The primary care provider is a cornerstone of the health care system in most of countries.

▪ Including: primary care physicians (PCPs), physician assistants, and nurse practitioners

▪ PCP: generalists➔ family practice or internal medicine ➔ to address a wide range of conditions and illness

PCPs

▪ The first point of contact for patient; general practitioner.

▪ WHO: “along with other generalist medical practitioners, diagnose, treat and prevent illness, disease, injury, and other physical and mental impairments and maintain general health in humans through application of the principles and procedures of modern medicine.”

▪ Responsibilities: planning, supervising, and evaluating the overall care plan of a patient and will frequently counselindividuals on dietary practices, hygiene, and preventive health care; referring people to specialty care providers

MD vs. DO

▪ MD: doctor of medicine: allopathic physician (對抗療法); serve as PCP in family practice, pediatric, geriatric, or internal medicine setting.

▪ DO: doctor of osteopathic medicine: place a special emphasis on the alignment and health of the body’s musculoskeletal system, preventive medical care, and holistic patient care.

▪ Both are licensed, having a wide array of diagnostic and therapeutic interventions that the may perform and prescribe, and using all accepted methods of medical treatment.

Primary care physician assistants

▪ A clinician who provides health care services under the direction and supervision of an MD or a DO.

▪ Working on tight time schedules, to delegate some of the patient care responsibilities.

▪ Trained to perform many of the routine, time-consuming tasks that physicians face.

▪ Skills: taking medical histories, performing physical examinations, ordering routine laboratory testing, and providing care for minor injuries.

Primary care physician assistants…cont.

▪ Physician assistant (PA) and the nurse practitioner (NP)

▪ PA: specific training requirements; most completed a bachelor’s or master’s degree program, and followed by state board examinations.

▪ NP: advance-level nursing professionals, and carry out many of the same duties that a PA does. Allowed to provide PC services and perform many of the routine clinical tasks in a medical offices.

▪ NPs have greater autonomy than PA ➔ to practice independently and prescribe medications and rehabilitation care, such as physical therapy

Specialty care provides

▪ Choose to concentrate in one or more of wide variety of disease categories, certain types of patients, or particular methods of treatment.

▪ Also seek out teaching positions in medical education settings and undertake research activities in their chosen areas of specialization.

▪ Completion of a university-level degree in basic medical education + postgraduate clinical training in a medical specialization or equivalent

Specialty care provides…cont.

▪ Allergy and immunology (過敏&免疫科)

▪ Anesthesiology (麻醉科)

▪ Cardiology (心臟科)

▪ Chiropractic (脊骨神經醫學)

▪ Dermatology (皮膚科)

▪ Endocrinology (內分泌科)

▪ ……..

Check: What specialists do we normally

have?

Dentists

▪ Includes oral and maxillofacial surgeons (口腔及頜面外科醫生)

▪ Responsibilities: diagnoses, treats, and prevents diseases, injuries, and abnormalities of the teeth, mouth, and jaws; general practice, handling both routine and emergency dental cases

▪ Specialized diagnostic, surgical, pharmacological, and other approaches either to promote or to restore oral health.

▪ Pediatric care

▪ Periodontics (牙周病): gum and jaw diseases

▪ Prosthodontics (口腔修復學): bridges, crowns, dentures

▪ Endodontics (牙髓病): root canal treatment

A specialist in the diagnosis, treatment, and prevention of

injuries to and diseases of the teeth, mouth and jaw

Dental hygienists

▪ Duties: go well beyond the cleaning of teeth, conduct assessments and examinations of patients for oral diseases (e.g. oral cancers and gingivitis).

▪ Some states: allowed to provide some types of dental services, take impressions, place temporary fillings, take X-rays, and apply fluorides and sealants, and be certified to administer local anesthesia prior to further care being performed be the dentist

A health care professional who

providers preventive dental care and patient

education

Dental assistants

▪ Cannot perform teeth cleaning or most of the other duties of the dental hygienists.

▪ Duties: take care of many laboratory and day-to-day general office tasks (keeping the facility running smoothly and ensures that it is organized, clean, and well stocked with needed supplies), make and confirm appointments, organized dental records, to inventory supplies, and to seed out bills and assist in the processing of payments.

▪ Some states: retrieve records, prepare, and set out the instruments, and lean and sterilize various types of equipment, and hand instruments to the dentist during a procedure

A member o the dental care team who assists

the dentist in providing services

Mental health care providers

▪ Psychiatrists (精神科醫師): a medical professional who is trained in the diagnosis and treatment of mental illness.

▪ Subspecialties: addiction psychiatry, brain injury medicine, child and adolescent psychiatry, clinical neurophysiology, forensic psychiatry, geriatric psychiatry, hospice and palliative medicine, pain medicine, psychosomatic medicine, and sleep medicine.

▪ Psychologists (心理學家): an academic professional who is trained in the interactions among brain function, environment, and behaviors.

▪ Hold a doctoral degree (PhD, EdD, or PsyD) + 2 years of supervised professional experience + licenses

Mental health care providers…cont.

▪ Mental health care clinical nurses

▪ Registered nurse-psychiatric mental health (RN-PMH): an RN who is clinically competent in mental health nursing.

▪ Advanced practice registered nurse-psychiatric mental health (APRN-PMH): an RN who has passed the certification exam in psychiatric-mental health nursing.

▪ Psychiatric mental health nurse practitioner (PMH-NP): A nurse practitioner who provides a wide range od mental health patient care services.

▪ Social workers: A professional who helps to improve individuals’ quality of life through the coordination of available programs and services.

Nurses

▪ A critical portion of the health care workforce

▪ Provide treatment, support, and care services for all ill, injured, and aged.

▪ Help to plan and manage the care of patients with physical and mental illness

▪ Skilled in the practical application of many preventive and curative services, and can deploy these skills in either clinical or community settings.

Registered nurses, RN

▪ A health care professional who helps to treat patients, coordinate patient care, and provide patient education.

▪ With a highly educated individual; to help to treat patients, coordinate patient care, and provide patient education to individual patients, families, and the public about a variety of health conditions.

▪ Would specialized in one or more areas of care, and find employment in a large number of health care settings

Licensed practical nurses, LPN

▪ A integral midlevel nursing care provider who supports day-to day functions in the health care setting

▪ Works under the direction of physicians and RNs, providing basic nursing care services to the sick, injured, convalescent, or disabled.

▪ Working settings: nursing home, extended care facilities, hospitals, physicians’ offices, and home health care settings

▪ Normally provide bedside care: measure and recode vital signs, prepare injections, dress wounds, assist with personal care and hygiene, feed patients who need assistance, reposition patients, and help with ambulation and transferring.

Certified nursing assistants, CNA

▪ A basic-level nursing care provider who provides routine patient care and personal assistance services

▪ A hard-working professional who often the heaviest burden in terms of hand-on, routine patient care services

▪ Usually hired on an hourly basis to answer patient call lights, take vital signs, bathe patients, make beds, assist with dressing and other hygiene activities, feed patients, provide basic wound care, and also help with ambulation or transfer.

▪ Do not assess, interpret, make decisions, or delegate duties.

Other nursing level systems

Taiwan

Radiologic and imaging professionals

▪ Radiation: provide image of the inside of a patient’s body, and as a form of treatment for various diseases

▪ Radiologic technicians, diagnostic medical sonographers, nuclear medicine technologists, and radiation therapists

Radiologic technicians

▪ An imaging professional who takes radiographs using a variety of equipment

▪ Hold associate’s or bachelor’s degree and will also received specialized training.

▪ Help to prepare a patient for prescribed test or procedure, answer questions, check that the patient is not wearing accessories that will obstruct the images, and then correctly position the patient for the test or procedure.

Diagnostic medical sonographers

▪ A technician skilled in using sound waves to assess and diagnose a variety of conditions

▪ Hold a two- or four-year degree and specialized training

▪ Use specialize imaging equipment that directs nonionizing, high-frequency sound waves into a patient’s body to help assess and diagnose various medical conditions ➔ translates them into useful images that can be saved as videotapes or photographs or transmitted directly to a physician for interpretation and diagnosis.

Nuclear medicine technologists

▪ A professional who uses radioactive nuclides (unstable atoms that spontaneously emit radiation, 放射性核素) to diagnose and treat diseases

▪ To prepare and administer small amounts of radioactive substances called radiopharmaceuticals, as well as other medications, to patients for diagnosis and treatments.

Radiation therapists, RT

▪ A member of a medical oncology team who is skilled in using a linear accelerator to administer radiation treatments to treat cancer and other diseases.

▪ Images from diagnostic X-rays, MRI, or CT exams are used to pinpoint the location of a patient’s cancer or condition needing treatment.

▪ Provide with a curative intent (meaning that the treatment is given in the hope that it will cure a cancer either by destroying a tumor or preventing cancer recurrence, or both

Allied health rehabilitation professionals

▪ Physical therapist (PT): a clinician skilled in the assessment and treatment of physical injuries

▪ Occupational therapist (OT): a clinician who assists individuals with physical and-or emotional disabilities by teaching daily living or other related life skills.

▪ Certified athletic trainer: a health care professional who specialized in preventing, assessing, and treating musculoskeletal injuries and illnesses.

Allied health rehabilitation professionals…cont.

▪ Orthotist (矯正器製作師): a clinician who measures, designs, fabricates, or fits an orthosis for a patient.

▪ Prosthetist (義肢製作師): a clinician who measures, designs, fabricates, or fits an prosthesis for a patient.

▪ In Japan: Prosthetist and Orthotist (PO)

▪ Speech-language pathologist: a clinician who helps children and adults who have been diagnosed with speech or language impairments.

Allied health rehabilitation professionals…cont.

▪ Audiologist: a health care professional who works with children and adults who have hearing impairments.

▪ Art, dance, and music therapists: professional who are highly skilled in using their respective creative medium to enhance the therapeutic process.

▪ Horticultural therapist (園藝治療師): a therapist who uses gardening as a therapeutic technique.

Employment trends in the health care sector

▪ The job outlook and employment trends in the US health care system remain extremely promising and strong.

▪ Health care is the fastest-growing sector of the US economy.

▪ Workers face several on-the-job hazards, including needle-stick injuries, back injuries, latex allergies, patient-on-provider violence, fatigue, and stress.

▪ Wages issue

30

Employment trends in the health care sector…cont.

31

Employment trends in the health care sector…cont.

Fig 3.2: Projected change in total employment, selected health care occupations

Employment trends in the health care sector…cont.

▪ Advances in technology and innovations in pharmaceuticals ➔people to live longer than ever before.

▪ Aging of the baby boomer generation ➔ need for a variety of health care personnel in both the generalist and the specialty care areas.

Summary

▪ The current health care environment involves the work of many types of skilled individuals, knowledgeable in their particular disciplines and (optimally) working together in teams to fulfill the needs of each patient as an individual.

▪ Each health care professional is a link in the overall chain of care and is to be valued for the knowledge and contributions he or she provides.

Summary…cont.

▪ The importance of collaboration and communication among health care providers at all levels cannot be emphasized enough, as this has been identified as a critical point in preventing medical errors that cause both patient harm and patient deaths.

▪ Designing the healthcare provider of the future: Chad Priest at TEDxIndianapolis

▪未來的醫療是什麼模樣？ | 張智威 Edward Y. Chang | TEDxTaoyuan

Part Two: The Major Players in Health Care Service

Chap 4. Hospitals

林育秀, Ph.D.2020

Healey, B. J. (2015). Introduction to health care services:

foundations and challenges. Jossey-Bass, A Willey Brand.

History of hospitals

▪ Religious communities ➔ spiritual consolation

▪ 18th: medical education ➔ charitable organization

▪ 1st hospital in USA: The Pennsylvania Hospital, PA, caring for the insane and indigent sick (granted in 1951, completed in 1972)

▪ Features of early hospitals:

▪ Not-for-profit institutions: Organizations that conduct business for the good of the general public, without shareholders or a profit motive

▪ Relied largely on charitable contributions

▪ Patients: pay to out of pocket for care & services they received

History of hospitals in Taiwan

▪台灣第一所醫學院：在述說台灣現代醫療發展史時，通常推舉台大醫學院之前身「台灣總督府醫學校」為台灣第一所醫學院。但是馬雅各醫生在旗後開設的打狗醫院，於1886年由當時負責的梅醫生（Dr. Myers）擴建為萬大衛紀念醫院（David Manson Memorial Hospital），當時稱為慕德醫院(旗後醫館)，用以紀念熱帶醫學之父萬巴德之弟弟萬大衛，他曾在萬巴德之後，在打狗醫館工作。

▪ 3年之後，他在台南二老口街開設醫館和禮拜堂，這就是後來俗稱的「舊樓醫館」

▪馬雅各二世（Dr. James Laidlaw Maxwell, Jr.）在1900年接棒來到台灣，那時「舊樓醫館」租約到期，另外建造新的醫院，這也是「台灣第一家現代化的西式醫院」，取名為「新樓醫院」

Late 20th – early 21st century: difficult for hospitals

▪ Many smaller community hospitals have closed their doors or been swallow by large organization.

▪ With the changes in payment schedules and advances in technology, more treatments, procedures, and surgeries are now completed on an outpatient basis. ➔patients were more acutely ill than previously.

▪ Inpatients are also released from the hospital more quickly than they used to be, leading to a host of new difficulties and challenges for hospitals.

Management of hospital: the governing board 理事會

▪ The supervising body of a health care organization, and the ultimate overseer of the hospital. ➔ The hospital must have a effective governing body legally responsible for the conduct of the hospital as an institution

▪ Membership: may vary depending on the affiliation of the hospital, normally including: influential members of the community, or members of the clergy if the hospital has a religious affiliation.

▪ If the hospital is connected to a university, the university board of trustees may oversee the hospital as well.

▪ A multihospital system will have one governing board that oversees all the hospitals in the system.

Management of hospital: the governing board…cont.

▪ Responsibilities:

▪ Regulated by the Medicare conditions of participation for hospitals

▪ For ensuring that each patient receives safe and quality care

▪ Must develop an operating budget, which is reviewed and updated annually ➔ prepared according to generally accepted accounting principles, including all anticipated income and expenses, and provide for capital expenditures for a period of at least 3 years.

▪ All contracted services that are provide ➔ contracted services: services ranging from hemodialysis to housekeeping to security

Management of hospital: the medical executive committee (MEC)醫療執行委員會

▪ A body that represents and acts on behalf of the medical staff.

▪ Made up of the medical staff and must meet a set umber of times per year, as determined by the medical staff bylaws.

▪ The governing board is required: “to assure that the medical staff have bylaws and that they comply with state and federal law and requirements of the Medicare hospital conditions of participation (CoPs).”

Management of hospital: MEC and the medical staff bylaws 醫事人員章程

▪ Rules for self-governance of the medical staff

▪ Set forth in writing authority the MEC has and also how that authority is delegated and removed.

▪ The MEC including: customarily chaired by the chief or president of the medical staff, representation from nursing administration (the chief nursing officer), quality, finance, and other ancillary departments as need; as well as approve all policies and procedures.

▪ The MEC is required to have a special meeting generally referred to as the committee of the whole, and every member of the medical staff is invited to attend this meeting.

Management of hospital: members

▪ Chief executive officer (CEO): oversees the running of the hospital on a day-to-day basis, and reports directly to the board of directors and is wholly accountable to them.

▪ Other executives the organization: a chief administrative officer (CAO), chief medical officer (CMO), chief nursing officer (CNO), and a chief financial officer (CFO).

Management of hospital: the nursing department

▪ The largest department in a hospital.

▪ CEO ➔ CNO/nurse executive/vice president or associate vice president of nursing/chief clinical officer (R.N.) ➔ nursing patient care managers/patient care department managers ➔staff

▪ Hierarchal model of management (top-down) ➔Magnet recognition designation ➔ shared governance / councilor model

Management of hospital: the nursing department…cont.

▪ Shared governance: a professional practice model based clearly in the principles of partnership, equity, accountability, and ownership at the unit level where the point of service occurs.

▪ 1990s: a council structure had been instituted eliminated that structure.

▪ A resurgence of interest in shared governance, due to the nursing shortage and the increased interest in acquiring the Magnet designation.

▪ Nursing shortage problems: aging nursing workforce, intention to leave, turnover rate

▪ Goal: to increase nurses’ satisfaction and retention rates.

▪ The Department of Nursing at UMC commits to shared governance as the mechanism ▪ Creating an environment which

encourages continuous innovation, ongoing education, and a commitment to excellence

▪ Including accountability-based practice, open communication, collaboration, coaching and mentoring, team building, and mutual respect and trust.

The councilor model of shared governance model

▪ The councilor model was the most frequently implemented

▪ A type of shared governance involving multiple subcommittees and centralized committee that provides oversight

▪ The councilor model uses councils that act on behalf of staff to make decisions.

▪ The councilor model is difficult to implement due to the dispersion of accountability. The model does provide for a strong basis for behavioral change and the professionalization of nursing within an organization.

Horizontal and vertical integration

▪ Horizontal integration: coordination of activities across operating units at the same stage of the service delivery process.

▪ Involving grouping organizations that provide a similar level of care under one management umbrella, and consolidating the organizations’ resources to increase efficiency and utilize economies of scale, e.g.: multihospital systems, mergers, strategic alliances with neighboring hospitals to form local networks.

▪ Acquiring and combining prestigious hospitals and then achieving higher reimbursement rates from payers willing to pay more for their services, e.g.: Partners Health Care, University of Pittsburgh Medical Center, Sutter Health

Horizontal and vertical integration

▪ Vertical integration: coordination of services among operating units at different stages of the service delivery process

▪ Efficiency goals: manage global capitation, form large patient and provider pools to diversify risk, reduce cost of payer contracting

▪ Access goals: offer a seamless continuum of care, respond to state legislation

▪ Quality goals

Horizontal and vertical integration…cont.

▪ Vertical integration involves grouping organizations that provide different levels of care under one management umbrella, e.g.:▪ Physicians (primary care providers, physician-hospital organizations,

management service organizations, etc.)▪ Health plans or health maintenance organizations▪ Academic medical centers▪ Long-term care facilities, Home care facilities

Quality and safety in hospitals

▪ Medical error (IOM, 1999): a failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.

▪ Commonly occur in the course of providing health care: adverse drug events, improper transfusions, surgical injuries and wrong-site surgery, suicides, restraint-related injuries or deaths, falls, burns, pressure ulcers, and mistaken patient identities.

▪ Occurring places: intensive care units, operating rooms, and emergency departments.

▪ Costs: preventable medical errors cost between $17-29 billion per year nationwide.

Quality and safety in hospitals…cont.

▪ The Quality of Health Care in America Committee of the Institute of Medicine (IOM, 1999): To Err is Human: Building a Safer Health System.

▪ Setting the goal a reduction in errors of 50% over the next 5 years.

▪ The majority of medical errors do not result from recklessness on the part of any one individual or group. Mistakes are more often a systems failure; the result of flawed processes and conditions that have set up a person or group to fail.

▪ Health systems must be designed to be safer and to make it harder for people to make an error.

▪ It encourages health care organizations to create a culture of safety rather than one of finger-pointing and blame.

Strategies for improvement

1. Establish a national focus to create leadership, research, tools and protocols to enhance the knowledge base about safety.

2. Identify and learn from error by developing a nationwide public mandatory reporting system and by encouraging health care organizations and practitioners to develop and participate in voluntary reporting systems.

3. Raise performance standards and expectations for improvements in safety through the actions of oversight organizations, professional groups, and group purchasers of health care.

4. Implement safety system in health care organizations to ensure safe practices at the deliver level.

Culture of safety

▪ Culture of safety: an environment in which mistakes and near misses can be reported by employees without fear of retaliation.

▪ If employees fear ➔ rarely report the mistake made ➔underreporting of errors and a false sense of security.

▪ If employees reported ➔ the responsibility of the organization to investigate the mistake or near miss to determine what in the process likely caused the mistake ➔ The root cause analysis

The root cause analysis (RCA)

▪ A process for identifying basic or causal factor(s) underlying variation in performance.

▪ Carefully looked at and the processes fixed to ensure that the likelihood of the error occurring again is reduced.

Never event

▪ IT SHOULD NEVER OCCUR.

▪ A medical event that is both serious and preventable and thus should never occur.

▪ List of never events (CMS, 2012): bloodstream infections (BSIs, 血液感染), catheter-related urinary tract infections (CAUTIs, 導管相關尿路感染), and ventilator-associated pneumonia (VAP, 呼吸器相關肺炎).

The Joint Commission (TJC)

▪ An independent, not-for-profit organization that is the predominant standards setting and accrediting body in health care.

▪ More than 20,500 health care organizations and programs in the US.

▪ TJC’s Gold Seal of Approval: an organization must undergo an onsite survey by a Joint Commission survey team every 3 years.

▪ Health care organizations should be survey-ready every day regardless o when the TJC team or other survey team is expected.

The Magnet Recognition Program®

▪ A program that recognizes health care organizations for quality patient care, nursing excellence, and innovations in progression nursing practice.

▪ The Magnet Recognition Program® , the American Nurses Credentialing Center (ANCC)

▪ Each time a nurse resigns and has to be replaced, it costs a hospital between $22,000-64,000.

▪ 1983, the American Academy of Nursing Task Force surveyed 41 hospitals to summarize 14 characteristics which identify the hospital with higher retention rates and quicker filling vacancies ➔ Forces of Magnetism

Forces of Magnetism

1. Quality of nursing leadership

2. Organizational structure

3. Management style

4. Personnel policies and programs

5. Professional models of care

6. Quality of care

7. Quality improvement

8. Consultation and resources

9. Autonomy

10. Community and the health care organization

11. Nurses as teachers

12. Image of nursing

13. Interdisciplinary relationships

14. Professional development

New Model for ANCC's Magnet Recognition Program©

▪ A New Vision for Magnet

Forces of Magnetism Represented

▪ 14 Forces of Magnetism ➔ 5 model components.

▪ Focuses on measurement of outcomes and has streamlined the documentation process.

Benefits of Magnet organizations

▪ A growing body of research indicates that Magnet organizations enjoy

1. Lower nurse dissatisfaction and nurse burnout

2. Higher nurse job satisfaction

3. Lower registered nurse (RN) turnover

▪ Also impact patient outcomes, because nurses provide safer and higher quality patient care.

How does Magnet recognition benefit patients?

▪ Quality and Safety

1. Higher adoption of National

Quality Forum safe practices

2. Lower overall missed nursing care

3. Higher support for evidence-based

practice implementation

4. Higher nurse-perceived quality of

care

5. Higher patient ratings of their

hospital experience

▪ Patient Outcomes

1. Lower mortality rates

2. Lower failure-to-rescue rates

3. Lower patient fall rates

4. Lower nosocomial infections

5. Lower hospital-acquired pressure

ulcer rates

6. Lower central line-associated

bloodstream infection rates

The Next Wave of Hospital Innovation to Make Patients Safer

https://hbr.org/2016/08/the-next-wave-of-hospital-innovation-to-make-patients-safer

Conflict of interest (COI)

▪ To describe when an individual can be influenced by money or other considerations to act in a way that is contrary to the good of the organization for whom he/she works or the patient for whom he/she should be advocating in their best interests.

▪ In most health care organizations, conflict of interest disclosures are required for all employees who make purchasing decisions—including physicians and administrators—and include a series of questions to which the individual must respond no or, if yes, must explain.

COI Policies

▪ Many health care organizations have specific policies for physicians and executives regarding COI.

▪ Employees must disclose any COIs for themselves or their family members, including spouses. COI documents must be updated annually.

▪ HCMN manager is responsible for COI documentation and policy enforcement.

COI-disclosures questions

▪ Personal gifts

▪ Meals, invitations, and entertainment

▪ Attendance at industry-sponsored (and third-party industry sponsored) conferences, education sales, or promotional events

▪ Industry-sponsored scholarships and other education support for trainees

▪ Speaking, consulting arrangements, and advisory services with industry

COI-disclosures questions…cont.

▪ Fiduciary, management, or other financial interests with industry

▪ Detailing, trying, switching, or ordering

▪ Conflicts of commitment

▪ Site or facility access by industry representatives

▪ Publication/ghost-writing/ghost-authoring

▪ Free drug/product samples

Criminal Background Checks

▪ Majority of states now have authority to require criminal background checks (CBCs) for physician licensure.

▪ Reasons: increasing societal concerns about alcohol and drug abusers, sexual predators, and child and elder abusers.

▪ If CBC shows convictions, boards review the application, looking for level and frequency of criminal behavior, basing their decision on that, along with other materials submitted by the applicant, such as proof of alcohol and drug rehabilitation.

Employee turnover

▪ Linked to job dissatisfaction and job burnout.

▪ Job dissatisfaction: pleasurable or positive emotional state resulting from the appraisal of one’s job or job experiences.

▪ Job burnout: a prolonged response to chronic emotional and interpersonal stressors on the job

Methods to improve the retention of nurses

▪ Decreasing workloads

▪ Providing support staff

▪ Empowering nurse managers

▪ Increasing salaries

▪ Encouraging physicians to treat nurses as colleagues

▪ Improving the orientation process

▪ Providing paid continuing education

Assessing Quality of Work Life

▪ The health care manager needs to assess the quality of the work

environment, including employee job burnout and job

satisfaction. Some of the items to be included are:

1. job autonomy, variety and significance.

2. fairness of pay and benefits.

3. opportunities for promotion and advancement.

4. relationships with supervisors.

5. relationships with coworkers.

6. level of job burnout.

7. overall job satisfaction.

Allied Health Shortages

▪ Respiratory therapy is particularly affected, along with radiology technologists and certified nursing assistants.

▪ One survey found all three groups were dissatisfied with current work life, and claimed inadequate staffing was the “number one problem they face.”

▪ They felt health care professional shortages compromised patient care, and that turnover was impacting retention and recruitment.

Allied Health Shortages…cont.

▪ Recommendations included:

▪ increased salaries

▪ improved staffing ratios

▪ better health benefits

▪ more input into decisions

▪ flexible schedules

▪ increased support staff

▪ continuing education.

▪ These are all under the control of the health care manager.

Q & A