Kelly Vana's Nursing Leadership and Management. Группа авторов
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Table 2.1 Examples of Performance Measures by Category
Clinical care | Financial management | Human resources management | |
---|---|---|---|
Structure | Effectiveness Percent of nurses and physicians who are certified JC (formerly JCAHO) accreditation Presence of council for quality improvement planning Presence of magnet recognition | Effectiveness Qualifications of administrators in finance department Use of preadmission criteria Presence of an integrated financial and clinical information system and clinical decision‐making technology | Effectiveness Ability to attract desired nursing and medical practitioners and other health professionals Size or growth of nursing and medical staff Salary and benefits competitive with competitors Quality of in‐house staff education |
Process | Effectiveness Ratio of medication errors Ratio of nurse‐sensitive complications Ratio of health care‐acquired infection Ratio of postsurgical wound infection Ratio of normal tissue removed during surgery | Effectiveness Days in accounts receivable Use of generic drugs and drug formulary Market share Size (or growth) of shared service arrangements | Effectiveness Number and type of staff grievances Number of promotions Organizational climate |
Productivity Ratio of total patient days to total full‐time equivalent (FTE) nurses Ratio of total admissions to total FTE staff Ratio of patient visits to total FTE nursing and medical practitioners | Productivity Ratio of collections to FTE financial staff Ratio of total admissions to FTE in finance department Ratio of new capital acquisitions to fund‐raising staff | Productivity Ratio of front‐line staff to managers | |
Efficiency Average cost per admission Average cost per surgery | Efficiency Average cost per debt collection Debt/equity ratio | Efficiency Recruitment costs | |
Outcome | Effectiveness Case‐severity‐adjusted mortality Patient satisfaction Patient functional health status Number of deaths from medical errors | Effectiveness Return on assets Operating margins Size and growth of federal, state, and local grants for teaching and research Bond rating | Effectiveness Staff turnover rate Number of absenteeism days Staff satisfaction |
Source: Compiled with information from Shortell, S. M., & Kaluzny, A. D. (2006). Health care management (5th ed.). Clifton Park, NY: Delmar Cengage Learning.
It would be naïve to consider health care in the United States, as it is currently being delivered, as being an effective system of care. If that were true, it would imply that health care is based on shared values and goals; is organized around the patient; utilizes all pertinent information; ensures value‐based and quality‐based care; rewards quality care; is universally standardized and simplified; is available to everyone regardless of income, race, ethnicity, or education; is affordable; and reflects effective collaboration among clinicians and with patients. The World Health Organization (WHO) has put forth primary goals for what good health care should do: improve equity in health, reduce health risks, promote healthy lifestyles and settings, and respond to the underlying determinants of health (World Health Organization (WHO), 2019).
Consistent with these goals, Healthy People 2020 has also developed overarching goals to increase quality and years of healthy life and eliminate health disparities. These goals are:
Attain high‐quality, longer lives, free of preventable disease, disability, injury, and premature death.
Achieve health equity, eliminate disparities, and improve the health of all groups.
Create social and physical environments that promote good health for all.
Promote quality of life, healthy development, and healthy behaviors across all life stages (Healthy People 2020, 2010).
Real World Interview
What can be said about the United States health care system is that it is not really a system, but rather a hodge‐podge of systems, some great, some not so great, with a “sometimes” desire for universal service, but with also the fierce energy of independent individuals seeking autonomy.
Ellyn Stecker, MD
Shipshewana, Indiana
Health Care Rankings
Despite having the most expensive health care, the United States ranks last overall among the 11 countries on measures of health system equity, access, administrative efficiency, care delivery, and health care outcomes. While there is room for improvement in every country, the U.S. has the highest costs and lowest overall performance of the nations in the study, which included Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom. The U.S. spent $9,364 per person on health care in 2016, compared to $4,094 in the U.K., which ranked first on performance overall (Commonwealth Fund, 2017). An overall score of 64% was recently given to the United States for its achievement across 42 core health indicators related to long, healthy, and productive lives; quality; access; efficiency; and equity of health care (Commonwealth Fund, 2012) (see Figure 2.2).
Source: The Commonwealth Fund. (2012, January 15). Scores Dimensions of a High Performance Health System. Retrieved from https://www.commonwealthfund.org/chart/scores‐dimensions‐high‐performance‐health‐system.
Some major findings from the U.S. Scorecard include the following (Radley, Hayes, & Collins, 2019):
Rising death rates, high levels of obesity, and gaps in care are pressing challenges for states
The