Health Care Delivery for the 21th
Century
Advanced Skills for Health Care
Providers, Second Edition
Barbara Acello
Thomson Delmar Learning, 2007
Objectives

Spell and define terms.

Define workplace redesign and describe
changes in the nursing department that have
occurred because of restructuring.

Define the role, responsibilities, and scope of
practice of the Patient Care Technician, and
explain why standards of care are important
Objectives, continued
List the five rights of delegation and give
examples of situations in which
delegating a procedure to a PCT is not
appropriate.
Objectives Continued

Diffentiate an intradisciplinary team from
an interdisclipinary team and list some
general responsibilities of teams

List at least ten desirable qualities of the
PCT

Identify professional boundaries in
relationships with patients and families
SPELLING TERMS

WORKPLACE REDESIGN
 RESTRUCTURING
 RE-ENGINEERING
 MULTISKILLING
 CROSS-TRAINING
 PROCESS IMPROVEMENT
 QUALITY IMPROVEMENT (QI)
 QUALITY ASSURANCE (QA)
 CONTINUOUS QUALITY IMPROVEMENT
 BENCHMARK
 BENCHMARKING
SPELLING TERMS CONTINUED


CRITICAL THINKING
QUALITY INDICATOR
 ADVERSE EVENTS
 CLOSE CALLS
 INTENTIONALLY UNSAFE ACTS
 SENTINEL EVENTS
 ROOT CAUSE ANALYSIS (RCA)
 TRANSPARENCY
 INSTITUTE FOR HEALTHCARE IMPROVEMENT
(IHI)
 PATIENT FOCUSED CARE
 UNLICENSED ASSISTIVE PERSONNEL (UAPs)
SPELLING TERMS CONTINUED


NURSE PRACTICE ACT
STANDARDS OF CARE
 NEGLIGENCE
 MALPRACTICE
 DELEGATION
 DELEGATED
 ASSIGN
 INTRADISCIPLINARY TEAMS
 INTERDISCIPLINARY TEAMS
 INTRADEPARTMENTAL TEAMS
 INTERDEPARTMENTAL TEAMS
 PARAPROFESSIONALS
 TACT
Health Care Delivery from 1980 to
the Present

Health care is provided in many settings
 The type of care given is determined by the
type of services the agency delivers
 Health care workplace organization remained
largely the same for many years.
 Before the mid-1980’s, health care facilities
were set-up so that many departments
provided services to patients
CHANGES IN REIMBURSEMENT

Changes in reimbursement for health care
services began with the federal government in
the late 1970s.
 This was done to save Medicare money
 In the mid-1980s, changes began to have a
profound effect on the health care industry.
 These changes caused modifications in the
operation of physicians’ offices, clinics,
laboratories, hospitals, long term care
facilities.
WORKPLACE REORGANIZATION

Most health care facilities studied their
operations to see how they could become
more efficient.
 This was necessary because reimbursement
for services was less than it had been
previously
 Organizations had to figure out how to provide
the same services at a lower cost.
 Some hospitals closed because they could not
operate on lower revenues
WORKPLACE REORGANIZATION





Many agencies learned that they could save
money if they combined the services that
departments and workers deliver.
Small departments merged, becoming part of
larger departments
The workers were taught to perform new
patient care procedures.
Now fewer workers provide a broader
spectrum of care.
Collectively, these changes are called
workplace redesign.
EFFECTS OF WORKPLACE
REDESIGN
In most health care agencies, the
nursing department’s responsibilities
have been expanded
 Staff is given additional training in
procedures that nursing was not
responsible for previously
 Training of this type is called multiskilling
or cross-training

EFFECTS OF WORKPLACE
REDESIGN

The multiskilled worker has completed a basic
nursing assistant or other educational program
to learn to provide personal care and basic
comfort measures to patients
 The assistant attends classes to learn
additional technical skills.
 Most agencies have changed the assistant’s
title to reflect the changes in responsibility.
QUALITY ASSURANCE
All health Care Facilities have an interval
program for process improvement.
This is commonly called quality
improvement or quality assurance or
continuous quality improvement.
 The purpose of quality assurance is to
identify problems and potential and find
solution for improvement.

BENCHMARKING
Benchmarking is an important part of the
quality improvement process.
 Benchmarking is an activity in which an
organization establishes best practices
by comparing what it is doing with what
other similar organizations are doing
 By benchmarking with other
organizations, the facility can improve its
processes and achieve excellence

QUALITY INDICATORS
 Quality
indicators are decisionmaking and research tools that are
used for tracking changes,
recognizing potential quality
problems and identifying areas that
warrant further study and research
Serious Events

Adverse events- incidents, accidents, events
and injuries associated with patient care and
services.
 Close calls- Situations that could have
resulted in an adverse event but did not.
 Intentionally unsafe acts- results from
criminal acts, purposefully unsafe actions
 Sentinel events- Serious injury that result in
patient death or serious physical or
psychological death
ROOT CAUSE ANALYSIS

Root cause analysis or RCA is a process for
identifying the cause or contributing factors
associated with untoward events
 Every facility has guidelines for conducting a
root cause analyses investigation
 Transparency- is the part of the investigative
process that involves keeping people informed
PATIENT- FOCUSED CARE
The purpose of patient focused care is
to bring services to patients, instead of
bringing patients to services.
 Fewer workers are needed to provide
services to each patient under this model
of care.

Role and responsibilities of the
Patient Care Technician
The role of the PCT vary from one
agency to the next.
 Understanding what you can and cannot
do is very important
 Your employer will give you a job
description, listing your responsibilities.
A sample job description is given in
figure 1-3

Nurse Practice Acts
Nursing practice is regulated by a board
of nursing or other governing body in
each state.
 The nurse practice act describes the
nurses scope of practice in your state.
 Never perform procedures that you have
not been taught to provide, or that are
illegal for patient care technicians in your
state.
