The Future of Health Care: Are You Prepared?
Barbara J. Ritter, Ed.DNP
and Donna C. Geiger, MSN, FNP
Throughout the last decade, the Institute of Medicine (IOM), an inter-professional panel of experts in clinical medicine, medical education, the medical and biological sciences, nursing, dentistry and other health professions, has published a series of reports on quality and safety in healthcare.The reports, with their evidence-based focus, have increasingly been used to guide informed decisions for changes in professional practice that will improve the quality of health care. Currently, implementation plans for the recommendations are beginning to gel with the formation of state-level Regional Action Coalitions (RACs).How best can we use these recommendations to improve our practice and our profession?
Institute of Medicine Reports
The first report in the series,To Err is Human: Building a Safer Health System (1999), provided the groundwork for reform by alerting us all to the estimated 98,000 preventable deaths per year attributable to quality and safety deficits in the health care industry.This report was followed by Crossing the Quality Chasm: A New Health System for the 21st Century (2001), which concluded, “care should be safe, effective, patient-centered, timely, efficient and equitable”. A subsequent report, Health Professions Education: A Bridge to Quality (2003), operationalized those characteristics by identifying specific competencies that are essential to increasing safety and quality regardless of the health care discipline (Texas Higher Education Coordinating Board, 2008).
IOM Core Competencies
The set of core competencies that all health professionals regardless of discipline will demonstrate are: 1) the provision of patient-centered care, 2) working in inter-professional teams, 3) employing evidence-based practice, 4) applying quality improvement approaches, and 5) utilizing informatics (Institute of Medicine Reports, 2003).
These core competencies were further delineated specifically for nurses in the Quality and Safety Education for Nurses (QSEN) Report (2007), an ongoing research project funded by the Robert Woods Johnson Foundation.The QSEN competencies are the same as the IOM competencies with the addition of safety. The project integrated the IOM recommendations into nursing curricula and provided a framework to meet nursing practice competencies as well as serving as a national resource for curriculum models and sharing teaching strategies.
Herein lies the genius of the conceptual frameworks created by the IOM and then refined in the QSEN report –a set of competencies that all health care disciplines can use to guide their practice.
While nursing leaders embraced these quality improvement indicators, concerns about scope of practice remained in the forefront. The Future of Nursing: Leading Change, Advancing Health (2011), emphasized that if the system is to capitalize on this opportunity for change, the constraints of outdated policies, regulations, and cultural barriers, including those related to scope of practice, will have to be lifted, most notably for advanced practice nurses (APNs).This “remodeling” would allow for practice to the full extent of education and training achieved, creating more accessible, high-quality, value-driven services in full partnership with physicians and other health professionals.
However, we miss the point if we only focus on recognizing and removing constraints to our practice.The IOM reports clearly indicate that APNs routinely deliver primary care services on an equal level with their physician partners as do APNs in specialty practices. Multiple studies have proven this long ago.
In relation to our physician colleagues, this newest generation - the primary care physicians, surgeons and the cadre of new specialists - recognize that the paternalistic captain of the ship model is no longer achievable let alone effective.There is recognition that “the pace and commercial nature of health care impede the inculcation of fundamental values of the profession” (Cooke, Irby, & O’Brien, 2010). For nearly a decade, Grunbach & Bodenheimer, (2002) have acknowledged that all these fundamental values are being impeded and the fundamental value (or “core competency” in our new language) that is most affected is patient centered care, necessitating a paradigm shift to collaborative teams. In 2010, The American College of Physicians, a group made up primarily of internists, reinforced this point in their position paper concurring that the future of health care delivery would require multidisciplinary teams of health care professionals.
All the IOM reports point to improved communication, teamwork and collaboration as the best way to improve our health care delivery system. Major medical and nursing societies are embracing this opportunity for real change.
Thus, we can empower ourselves by demonstrating that our care is patient centered, recognizing that we are valued members of an interdisciplinary team, who evaluate the evidence, strive to improve the quality of our care and use technology to achieve all of the core competencies for the improvement of health care.
The power to change conditions in order to deliver better care does not rest primarily with our profession, regardless of how ably led or educated we are; it also lies with governments, businesses, health care institutions, professional organizations and other health professionals, and the insurance industry.
The IOM future of health care recommendations see APNs as partners practicing to the full extent of their abilities. With this new language we have a foundation for true collaboration. Together, we have the power to transform a broken health care system providing seamless, affordable, high-quality care that is accessible to all, patient centered, and evidence based to improve health outcomes.Thus, the future of nursing – and that of all the health care related disciplines – will likely depend more on how the core competencies are integrated into our educational system and, especially, our practices. Are you prepared for the future of heath care?
Grumbach, K, & Bodenheimer, T. (2002). A primary home for Americans: Putting the house in order. JAMA, 288(7), 889-893.
Institute of Medicine (2011). The future of nursing: Leading change, advancing health. Washington, D.C.: National Academies Press.
Dr. Barbara Ritter is Webmaster for North Bay Chapter of California Association for Nurse Practitioners, Research Director of Marin Nurse Practitioner Association, and former Director of Advanced Practice Programs at University of San Francisco. She also practices as an NP in private practice.
Donna Geiger is a Professor of Nursing at Napa Valley College. She also practices as a NP at Petaluma Health Center.
Published in CANP Connections - Summer 2011.