1. Understand the theory and principles that underpin based practice
Explain outcome based practice
In 1990 health care providers had just began to discover what appeared to be a very powerful tool for reducing variation in patient care practices - clinical paths. A clinical path includes descriptions of key events that, if performed by caregivers as described, are expected to produce the most desirable outcomes for patients with specific conditions or procedures. By the late 1990s, caregivers started to question the benefits of clinical paths. Organizations reported problems integrating the pathway document into patient records, thus dampening caregiver enthusiasm for using the pathway. Physicians, nurse, and other clinicians found the pathways difficult to apply to all patient populations. A variety of factors may be causing clinical paths to look like yesterday’s failed solution, when in fact the lessons learned during years of pathway development are being put to good use in many organizations. Today caregivers are adopting outcomes-based practice methods to achieve desired patient care goals. Outcomes-based practice (sometimes called outcomes management) involves a combination of teamwork, continuous quality improvement, and process and outcome measurement. These collaborative multidisciplinary efforts build on the pathway development work of the 1990s. It’s quite likely that outcomes-based practice would not have been possible if caregivers hadn’t learned how to work together while designing clinical paths. All of those multidisciplinary meetings to develop paths were not a waste of time! Paths and Outcomes-Based Practice
Caregivers have discovered that an “as needed” pathway philosophy seems to work best. Clinical paths were never intended to solve every documentation challenge, eliminate every unnecessary cost, or be used for every patient. Instead of trying to develop an unlimited number of clinical paths, organizations are now adopting outcomes-based practice as the goal. Paths are viewed as one of the many different tools caregivers can use to achieve that goal. An outcomes management initiative starts with the decision to improve clinical care for a particular group of patients. All involved caregivers must agree that it is important to study and improve the process. Improving a clinical process is hard work and unless the physicians, nurses, and other team members are rooting for project success, their interest in the initiative will be short-lived. Administrative and medical staff leaders should jointly define the goals for the project. Once the patient population for the project is chosen a multidisciplinary team of people involved in caring for these patients is formed. After studying current patient care practices, the outcomes management team selects the actions necessary for achieving the project goals. What people have learned from their clinical pathway experiences is that the process improvement actions should be chosen after everyone knows what needs fixing. Otherwise organizations end up with "solutions in search of a problem" rather than measurable improvements. Any number of actions can be taken to achieve the goals of an outcomes management project. For example, if data show that physician practices vary widely for no particular reason and reducing variation is a goal, then physician-friendly tools are developed. It’s unlikely that physicians will use a clinical path located in the nursing section of the patient’s hospital record. That’s why hospitals are designing physician-friendly point-of-care reminder tools such as pre-printed order forms. As order entry becomes computerized, written order sets can easily be converted to an electronic format. Computerized decision support systems are another effective tool for changing physician practices. These automated systems offer physicians point-of-care treatment advice for a...