Leadership

Overview of Healthcare Delivery Systems

• The lecture covers healthcare delivery systems and leadership.

• Importance of understanding healthcare systems to educate and empower patients.

Provision of Healthcare

• Intense debate for over a century on healthcare as a right vs. privilege.

• Different views:

  • Healthcare as a right: Moral obligation of society to provide healthcare to everyone.

  • Healthcare as a privilege: Access based on personal choices, income, and ability to afford care.

• Comparison to transportation (e.g., cars) - not considered a societal obligation.

Complexities in Healthcare Rights

• Questions raised:

  • Do individuals with risky behaviors deserve the same healthcare as others?

  • Should the homeless or unemployed receive healthcare funded by taxpayers?

  • Is vaccination status a criterion for resource allocation in critical care?

Perspectives on Healthcare Accessibility

• American Association of Nurses (AA): Advocates for accessible healthcare for all, viewing it as a basic human right.

• Key issues in the US healthcare system: Access, quality, and equity.

International Healthcare Comparison

• Commonwealth Institute: Annual reports comparing healthcare systems of high-income countries (e.g., Australia, Netherlands, UK) to the US.

  • US ranks last in most measures of access, equity, and outcomes despite high performance in care delivery.

Health Outcomes Discussion

• US has high-quality trauma care, yet ranks poorly in preventable disease outcomes, e.g., infant mortality and chronic diseases.

• Factors attributed to lifestyle choices and healthcare access problems.

Healthcare Models

• Socialized Healthcare (e.g., Canada): Funded through higher taxes, providing universal access.

• US Model: Mixture of private and government provisions (e.g., Affordable Care Act).

Affordable Care Act (ACA)

• Goal: Increase access to affordable health insurance.

• Many remain underinsured, facing high premiums and costs despite having insurance.

• Some states penalize individuals for not having insurance.

Challenges of Affordability in Healthcare

• Underinsurance: Individuals have insurance but cannot afford care (high out-of-pocket costs).

• Limited insurance choices complicate patient access.

Healthcare Team Members

• Various roles include:

  • Physicians (MDs, DOs)

  • Physician Assistants (PAs)

  • Registered Nurses (RNs)

  • LPNs and Nurse Practitioners (NPs)

  • Therapists, Dietitians, Pharmacists, Spiritual Care, and Unlicensed Assistive Personnel (UAP).

Levels of Healthcare

• Primary Care: Focus on prevention and health promotion.

• Secondary Care: Diagnosis and treatment of diseases; often in hospitals.

• Tertiary Care: Management of complex conditions requiring specialty care.

Healthcare Cost Components

• Out-of-pocket payments, Medicare, Medicaid, CHIP, and WIC.

• Growing aging population and increased poverty affecting funding for Medicare and Medicaid.

Healthcare Leadership and Delegation

• Five competencies for nurse leaders:

  1. Communication and relationship management.

  2. Knowledge of the healthcare environment.

  3. Financial management skills.

  4. Leadership and visionary thinking.

  5. Professionalism and ethics.

Delegation in Nursing

• Definition: Assigning responsibility to others while retaining accountability.

• Five Rights of Delegation:

  1. Right task

  2. Right circumstances

  3. Right person

  4. Right direction and communication

  5. Right supervision and evaluation

Conclusion

• Nurses play a critical role in healthcare delivery and must navigate complex systems to advocate for patients effectively. The balance between leadership, delegation, and advocacy is essential for quality patient care.