Managing Outcomes, Process, and Cost in a Managed Care Environment

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<ul><li><p>AUGUST 1998, VOL 68, NO 2 </p><p>position to move forward and tit into the new emerging paradigms. Unfortunately, not all nurses will fit into the new corporate model of health care delivery. The challenge is to be ready. There is an increas- ing preference by consumers to seek out services that provide what industrialized medicine has not been able to provide: a sense of meaning, a sense of connectedness, and help with healing. </p><p>Nurses need to take the initia- tive to develop the skills, attitudes, and vision that the new system will require. They should assist employers in meeting the demands of a public that expects the best health care in the world. Additionally, they need to look to the major focus of moving deliv- ery from hospital acute care to freestanding/ambulatory centers, home health services, and inde- pendent advanced nurse practice. </p><p>This book is available from Aspen Publishers, Inc, 200 Orchard Ridge Dr, Suite 200, Gaithersburg, MD 20878; (800) 234-1660. </p><p>NORRIE 1. MAcILRAITH RN, MS, CNS </p><p>CONSULTAN1 N. MAC LIMITED: NURSINQ FACETS </p><p>MASON CIN, IOWA </p><p>MANAGING OUTCOMES, PROCESS, AND COST IN A MANAGED CARE ENVIRONMENT By Roey Kirk 1 9 9 7 , 2 6 0 ~ ~ $60 spiralbound </p><p>ertainly, the advent of man- aged care has challenged the c old ways of doing business </p><p>or managing. Managers are expected to plan and lead through process and system designs. The management objective is to achieve outcomes efficiently and </p><p>effectively. The measurement and performance assessment of these outcomes will require data. Data and the management of that data will determine the successful health care manager. </p><p>In the past few years, a pletho- ra of books and articles have been written regarding the management of data. The techniques revolve around the changing environment and how to plan, design, measure, and assess. The goal of this book was to simplify this variety of methods to give managers a vari- ety of options. </p><p>bound book follow the integrated quality management model for data or outcome improvement. Chapter 1 provides a quick, but in- depth, review of the total quality management model. This model combines concepts from many different models and theories. It includes information about improving organization perfor- mance, integrated and supportive systems, individual ownership and accountability, customer-driven care, service, leadership, culture, mission, vision, and communica- tion, all the buzzwords and ele- ments being discussed and acted on today. The chapter gives exam- ples of employee empowerment and customer interviews and pro- vides a worksheet with examples of care or service indicators, per- formance or process indicators, and financial indicators. </p><p>process must be dependable, affordable, and reimbursable. Examples of successful process designs and worksheets for deter- mining the financial aspects are given. Data-driven management must not only design a system that reliably delivers high-quality care at the lowest possible cost but also </p><p>The five chapters of this spiral- </p><p>Chapter 2 explains that the best </p><p>must verify and document the extent of the success. </p><p>Data collection, display, and analysis are explained in Chapter 3. Assessment and analysis turn data into information. The use of the indicator assessment plan con- tinues in this chapter. Data trends and patterns, costbenefit analysis, diagrams, and benchmarking are a few of the terms clarified. </p><p>The core of management is the improvement of performance. The objective of process outcomes and the use of data is reflected in the pursuit of continually improving performance results. This is the last step in the model, but the one that plans for the future by decid- ing the results of the design, col- lection, measurement, and analy- sis of the process. Chapter 5 explains what to do if the indica- tors are met, not met, or exceeded. The books appendix provides examples, checklists, worksheets, assessments, and hints regarding facilitator and group processes. </p><p>The author has written an excellent guidebook for data-dri- ven management tools. It is easy and fun to read. The examples are relevant. The worksheets apd for- mats are applicable in any setting. Various quotations and sketches are used throughout the book. I have referred this book to depart- ment managers to use in introduc- ing change and process improve- ment to their units and to clinical improvement departments as an easy-to-use reference. </p><p>This book is available from Aspen Publishing, Inc, 200 Orchard Ridge Dr, Gaithersburg, Md 20878; (800) 234-1660. </p><p>SUSAN PHILLIPS RN, MHA, CNOR </p><p>ALLEOIANCE HEMIWARE CLINICAL PROJECT MAMAQER </p><p>&amp;ERflElD, IU </p><p>299 AORN JOURNAL </p></li></ul>