NURS 300 Knowledge Check

define policy

a set of statements of principles, values and intent that outlines expectations

provides a basis for consistent decision making and resource allocation in respect to a specific issue

define health policy

a broad range of strategies and activities in public health, healthcare, and intersecting social systems that are important to people’s well-being

what is included in policies

laws, regulations, actions and decisions implemented in the health sector and beyond

What types of organizations are involved in the devlopment, implement and evaluating of health policies

health authorites

governments

community organizations

patients

professionals

why are health policies useful

clarifies values

defines a vision for the future → establishes objectives and priorities

facilitates setting targets and milestones for short/medium term

clarifies challenges and effective ways of tackling them

strengthens consensus

helps to understand expected roles

what is the canada health act (CHA)

canadas federal legislation for publicly funded health care insurance

“to protect, promote, and restore the physical and mental well-being of residents of canada and to facilitate reasonable access to health services without financial or other barriers”

define RN regulation

include nurses who:

• passed canadian registered nurse examination OR

• the quebec examination

• have registered with their provincial/territorial regulatory body

define registered psychiatric nurse regulation

provide nursing care, supportive counselling and lifeskills to patients in psych hospitals, mental health clinics, LTC and community based settings

define LPN regulation

provide nursing care under direction of medical practitioners, RNs or other HCP

5 steps of policy development process

1. agenda setting

2. formulation

3. adopting policy

4. implementing

5. evaluating outcomes

what are the policy making frameworks

• synthesis of knowledge

• knowledge transition

• other policy inputs (economics, interest group lobbying, election pressures)

• policymaking

• implementation of policy

• evaluation of policy

problem identification when making policies

a health related issue is ID, usually as a problem

• nurse can help to frame issue (creating a particular perspective)

policy development process for: problem identification

agenda setting: refine issue through political process (negotiation and debate)

formulation: different interventions are proposed

adoption: proposed intervention is selected

implementation: carrying out the intervention

evaluation: does it achieve desired goals?

what is policy analysis

a process/technique for understanding the nature, intent and impact of policy

assess strengths and weaknesses of policy

define politics

using power to influence, persuade or change

why do politics exist

because resources can be limited and some people control more than others

what are stakeholders?

they are vested interest groups that control healthcare resources

• they exert political pressure on health policy makers to work to their economic advantage

who controls health care

those with political power and influence

nurses role with healthcare politics

• partners in compete, negotations, collaborations with stakeholders

• understanding the impact

• key informants for healthcare

• ethical and moral obligation in relation to broad societal issues

define health inequalities

differences in health status among population groups defined by specific characterestics

can be d/t biological factors and individual choices

define health inequities

differences in health that could be avoided if reasonable action was taken (unfair and socially unjust)

d/t the unequal distribution of the social and economic factors that influence health (SDOH)

actions nurses can take to help eliminate avoidable disparities

• pursue roles in advocacy, partnering, policy change

• create enabling environments and reduce poverty

• advocate for change and human rights

• create partnerships for change

• protect civil rights

• conduct research

define advocacy

• “the act of supporting or recommending a cause or course of action, undertaken on behalf of persons or issues. It relates to the need to improve systems and societal structures to create greater equity and better health for all. Nurses endeavour, individually and collectively, to advocate for and work toward eliminating social inequities”

what does advocacy involve

• engaging others

• excercising your voice

• mobilizing evidence to influence policy and practice

what makes a politically active nurse

• voicing concerns

• making demands

• advocating for others

strategies for developing political skills

• run for office

• seek appointed positions

• develop powerful professional image

• continue education

• develop networking skills

define policy briefs

provides a concise summary of a specific issue

options for addressing issue

recommendations for action

based on larger evidence synthesis or research studies

target an informed, non-specialist audience

define position statements

guide the profession, amplify views of nursing and educate consumers and decision makers

increase public awareness/knowledge

what is a fact sheet

document that provides data about an organization, product/service or data

displays key info that is easy to read

Define health system

The people/resources/institutions who come together to improve the health of the population they serve while responding to people’s expectations and protecting them against ill-health through activities whose primary intent to improve health

What is the purpose of a health system

Promote, restore and/or maintain health

What makes up a good health system

robust financing mechanism

a well-trained and adequately paid workforce

reliable information on which to base decisions and policies

infrastructre: well maintained

3 functions of health care systems

financing: how is it paid for

funding: the way provinces and territories health plans pay the provider for care

delivery: the method used to provide healthcare to the publci

roles and responsibilites of the canadian healthcare system

shared between provincial, territorial, federal government

what is the name of the canadian medical care system

canadian medicare

how is health care funded

primarily by the provinces and territories

• each has their own insurance plans

  • recieves cash assistance from federal govn’t on per-capita basis

financing: how is healthcare paid for in canada

mostly from taxes

private insurance premiums

how much does financing does the CHA do

reasonable access to medically necessary hospital, physician and diagnostic services without paying out of pocket

what does private health insurance cover

vision/dental care, prescription drugs, rehab services and home care

Roles and responsibilites of the federal governemtn

• funding support through canada health transfer fund

• support care delivery for health services to specific groups

• setting/administering national standards

• regulating safety/efficacy of medical devices, pharmaceutical, funding health research etc)

provincial/territorial governemnts financing

• Provinces and territories administer their own health insurance plan

• Financing and organizing health services within their jurisdiction

• They decide how much money to spend on health services, where to deliver these services, where to locate hospitals, and how many doctors are needed

funding: provincies and territories pay the providers for care how?

• Main form funding for physicians is fee-for-service, where they are paid separately for each service they provide.

• Hospitals and public health are funded with global budgets (Lump-sum payment given to hospital based on number and type of cases treated.

• Communities (home care and nursing homes) are funded on a fee-for-service basis or by fees per day

delivery of health services

• Delivery methods operate separately (i.e., hospitals have their own boards of directors, physicians work independently).

• Most hospitals are not-for-profit; some long-term care facilities operate for profit; prescriptions are paid by insurance companies or out of pocket

factors influencing healthcare in canada

• New technology

• Aging population

• Increasing cultural diversity

• New diseases

• Information management

• Globalization 

• Social determinants of health

• Accreditation

• Regulatory bodies 

• Professional associations and unions 

what causes healthcare costs to escalate

• Price of services delivered

• Utilization

• Inflation in price of drugs and supplies

• Increased labour costs

• Attitudes and behaviours of health care consumers

• Health care financing

• Changing population demographics

Define accountability

emphasizes keeping agreements and performing tasks in a respectful manner. It is NOT a bout blaming, it is about learning and continuous improvement

A culture of accountability is important for improved quality of care and value for money spent on healthcare

What is the Accord Healthcare Renewal

• Primary health care renewal; 

• Supporting information technology (e.g., EHRs, telehealth); 

• Coverage for certain home care services and drugs; 

• Improved access to diagnostic and medical equipment, and better accountability from government.

What happened after the accord on Healthcare Renewal was made?

• According to the Accord, Federal government cash transfers increased, and the Canada Health and Social Transfer (CHST) was split into:

  • The Canada Health Transfer for health and;

  • The Canada Social Transfer for postsecondary education, social services, and social assistance

Federal Commission Reports

• Sustaining service, needs and resources, new governance

• Sustaining Medicare

• More comprehensive use of information management and technology

• Investing in health care providers

• Primary health care and prevention

• Improving access and ensuring quality

• Rural and remote communities

• Home care services

• Prescription drug

• Aboriginal health

• Globalization

define scarcity

Resources exist in finite quantities, and consumption demand is greater than existing resources

Define choice

Decisions are made about which resources to produce and consume among options

Define preference

Individual and societal values and preferences influence the decisions that are made

Define cost

For the provider), the total amount incurred in providing a service, including procedures, therapies, and medications. The actual cost is typically lower than the price paid. 

Define price

also fee, rate, Tariff): Financial amount that a purchaser (i.e., health insurer) or individual pays to a provider to deliver a service. 

Define supply

When the selling price of an item rises, more people will produce the item because they can make a profit. 

Define demand

When the price of an item is reduced, the demand for it increases. This means there is a balance. As a price increases, demand decreases, and vice versa. 

what are the key elements of health economics

Price and cost

supply and demand

cost effectiveness

efficiancy

value

Cost effectiveness

The introduction of any health technology, whether it is a new drug or a new medical device, is often associated with an increase in health care costs and can limit the funding available for other interventions.

A cost-effectiveness analysis estimates costs and outcomes of interventions on the same outcome.

What is the benefit of measuring cost effectiveness

Helps policymakers, HCP, and insurance companies determine whether the new intervention is cost-effective in comparison to other interventions affecting the same outcome

Efficiency

Economics is about resource allocation and efficiency in resource use (getting the most from available resources).

Avoiding waste (including waste of equipment, supplies, and people) or using healthcare resources to get the best value for the money. 

value

Value in health care is measured by the health outcomes achieved, not the volume of services delivered, and shifting focus from volume to value is a central challenge. 

define transparency with budgets

a budget must align with the strategic directions and goals of the organization.  Alberta Health Services has 4 organizational goals.  The fourth goal is to improve financial health and value for money.  

define accountability with budgets

every manager must understand what’s included in their budget so they can be accountable.

define sustainability with a budget

we need to be able to plan for times of financial constraint, find ways to be more effective and efficient and plan for long term 

what is a budget

A budget is a financial plan for income (Revenue) and expenditures (amount of money spent) in a one-year period 

How long are budgets usually developed for

For a 12-month period

What is a fiscal year

Fiscal year (e.g., April 1 – March 31) is determined by the organization, province/territory. Can vary from one organization to another

How often are budgets monitored?

Monthly

Accounting

An activity that managers engage in to record and report financial transactions and data

Budgets

Help define services (costs)

Require forward thinking (planning)

Serve as benchmarks

Typically, are monitored monthly

Foster collaboration between departments

What are operational budgets

Financial tools that outline anticipated revenue and expenses over a specified period 

Operating budgets

account for income and expenses associated with day-to-day activity within a department or organization.

Capital budgets

account for the purchase of major new or replacement equipment

Construction budget

are developed when renovation or new structures are planned

Info to gather to prepare a budget: demographics

determine client characteristics and health care needs

Info to gather to prepare a budget: regulatory influences

Accreditation canada (AC) accredits health facilities to ensure they meet standards, their recommendations can affect operating budgets

Info to gather to prepare a budget: strategic plans

map out the direction for organization over several years

budget prep: department scope of service and goals

Hospital systems are frequently divided into subsections or units, commonly called cost centres. Each cost centre defines its own scope of service.

Departmental goals may include the introduction of new technology, facilities, or services, which may result in additional expenses for staff, equipment, and supplies.

budget prep: history

organizations look at past budget info to establish

• baseline for department or unit

• patterns of a departments growth or decline over time

define revenue

income generated through variety of means

define expenses

determined by identifying the cost associated with delivery of service

• may include labour, supplies, equipment, space, utilities etc

what are some major sources of expenditure

supply

human resources

why is human resources a big source of expenditure

salaries/benefits = 80% of HC budgets

calculations = based on amt of staff required to complete a service

staffing models outline the number of staff

How does a nurse manager impact the budget

• Recruitment of new Nursing staff and retention of existing Nursing staff.  

• Turnover of staff.

• Increased absenteeism.

• Positions not filled. 

Unit manager strategies to decrease HR costs: Efficient recruitment =?

• project vacancies

• post the position, interview and select in a timely manner

• be proactive in building a casual pool of Nursing staff

Unit manager strategies to decrease HR costs: Managing people and employee engagement = ?

• create an environment of mutual respect and feeling valued

• job enrichment, work-role fit, safety (supportive manager and  coworkers

• praise, appreciation, performance feedback/development conversations 

Unit manager strategies to decrease HR costs: Good enough skill mix on a unit =?

• Are there enough Registered Nurses for the patient acuity level?

• Are Nursing Staff spending a lot of time on tasks that can be completed by another job classification? E.g., Use of porters for non-nursing tasks.

Unit manager strategies to decrease HR costs: Is the nursing workload to heavy?

• This will again contribute to employee fatigue and overtime which leads to more absenteeism. It is often a better investment to supplement the Nursing staff. e.g., 4 hours added Nursing hours.

Unit manager strategies to decrease HR costs: Absentees and work-life balance

• discussions with employees with increased absenteeism and directing them to the Family Assistance program. 

• Vacation; encouraging employees to use it.  Work/life balance.

Unit manager strategies to decrease HR costs: Managing disruptive behavior

• Inappropriate communication, harassment, discrimination

Decreasing supply costs: general supply and wound care

• prevention of wounds will directly decrease wound costs

• cost of dressing and the frequency of changing the dressing, choosing the most appropriate product 

• supplies in the patient rooms – discarded at discharge.  

• Treatments change and result in waste of products. 

• COVID 19

Decreasing drug costs: medication reconcilliation on admission

• ensure accurate medication history and physician’s ordering.  Prevent adverse medications events that lead to increased costs.

Decreasing drug costs: drug utilization and stewardship

• promotes rational drug use to improve patient care and shows evidence of efficacy, safety and cost effectiveness

decreasing drug costs: antimicrobial stewardship

• use antibiotics wisely and preserve their value.  Decrease IV use of antibiotics and use appropriate step-down oral antibiotics. Decreased costs in drugs, supplies as well as nursing time. 

Other cost-conscious nursing practices

• Knowing and controlling costs

• Using time efficiently

• Evaluating the cost-effectiveness of new technologies 

• Predicting and using nursing resources efficiently

• Using research to evaluate standard nursing practices 

Strategic planning

Action plan with target dates and persons accountable

• can be 3-5 years

• serves to guide daily decision making and allocation of resources

• departmental strategies need to be consistent with the organizations strategic plan

Strategic planning process

Direction of organization (vision)

what you’re going to do and for whom (mission)

How to measure it and guide your strategy

Strategic planning: direction of organization

Vision

• provides a clear picture of what the future will look like; defines the key results achieved and goals that are to be accomplished  

Strategic Planning: What you’re going to do and for whom

• a formal expression of the purpose or reason for existence of the organization

Strategic planning: how to measure it and guide your strategy

goal

to get where you wanna be