Chapter 1 – Introducing Nursing Management  Nurses must be able to collaborate with others, as a leader, a follower, and a team member.  Today’s rapidly changing healthcare environment demands highly refined management skills and superb leadership.  Paying for Healthcare – Cost of Care: the cost of providing care is still the primary issue; cost of care controls access, availability, and even quality o The United States spends over $2.5 trillion on health care annually, more than any other country – the US spends more money on health care than any other country o In the past, healthcare providers were paid for the amount of care they gave patients.  System is being replaced by reimbursement for the quality of the care provided. o Affordable Care Act (ACA)  Healthcare reform was desperately needed to fix a system that rewarded more care and discouraged preventive care.  Cost of medical care continued to soar while many Americans lacked access to basic care.  Designed to provide quality, affordable healthcare for all Americans  Encourages healthcare organizations to establish accountable care organizations (ACO)  Changed how primary care providers offer care via a health home o Cost of Medical Errors  Both healthcare providers and insurers have mounted efforts to prevent such errors, including: falls, wrong site surgeries, avoidable infections, pressure injury, adverse drug events  Continues to climb  In addition to loss of life or diminished quality of life, actual dollar estimates put such costs at $17.1 billion annually.  Centers for Medicare & Medicaid Services (CMS)  Oversees government payments for care  No longer cover costs incurred by medical mistakes o Demand for Quality  Quality Management  A preventive approach designed to address problems before they become crises  Healthcare industry has adopted various strategies from the airline industry and other fields.  The philosophy of quality management is focus on the needs of the consumer.  Empowers the employee to evaluate quality  Leapfrog Group – focuses on quality indicators including the use of higher-performing hospitals for high-risk procedures  Consortium of public and private purchasers  Leverages purchasing power  Rewards organizations for quality measures  Benchmarking – uses an organizations outcome data and compares it with that of a similar organization to address strengths and challenges  Compares an organization's data with similar organizations  Uses outcome indicators to compare performance across organizations  Uses results to address weaknesses and enhance strengths  Evidenced-based practice  EBP steps o Identify the clinical question. o Acquire the evidence to answer the question. o Evaluate the evidence. o Apply the evidence. o Assess the outcome.  Evidence falls into several categories: o Anecdotal-derived from personal experience o Testimonial o Statistical-built from a scientific approach o Case study-an in-depth analysis used to translate evidence into other clinical situations o Nonexperimental design research-includes gathering factors relted to a clinical condition o Quasi-experimental design research o Randomized control trial  Ensure adequate training, recognition, and easy access to the internet  Magnet Recognition Program  Certifies health care organizations for nursing excellence