Health Care Delivery Models

Health Care Delivery Models
March 10, 2015
Leanne McLeod
LBWCC

The primary goal of all health care facilities is to provide safe, quality cost-effective to all patients. This is best accomplished when the number of staff members are closely matched to the number of patients. According to Cherry and Jacobs (2014), patient care delivery systems detail the way task assignments, responsibility, and authority are structured to accomplish patient care. Through different delivery systems different health care areas are able to perform safe, quality, cost-effective care to all patients. Such delivery systems include team nursing, primary nursing, functional nursing, total care nursing, and case management nursing. These delivery systems will be described in the following text along with which system is used at Mizell Memorial Hospital and the role of the case manager at Mizell Memorial Hospital.
“Team nursing is where a registered nurse (RN) functions as a team leader and coordinates a small group (generally no more than four or five people) of ancillary personnel to provide care to a small group of patients” (Cherry & Jacobs, 2014). According to Cherry & Jacobs (2014), the RN must know the condition and needs for all patients and plan for individualized care for each patient assigned to their team. The RN is also responsible for encouraging a professional working environment and maintaining clear communication among all team members. “the team leader’s duties include assessing patients and planning care, assigning duties, directing and assisting team members, giving direct patient care, teaching, and coordinating patient activities” (Cherry & Jacobs, 2014). Team nursing has been used in many inpatient and outpatient health care facilities and is an efficient method of patient care delivery. In order for team nursing to be an effective health care delivery model the RN must have strong clinical skills, delegating abilities, and an ability to maintain a professional working environment.
“In primary nursing, the RN, or “primary” nurse, assumes 24-hour responsibility for planning, directing, and evaluating the patients care from admission through discharge” (Cherry & Jacobs, 2014). With this health care delivery model the RN, while on duty, may provide total care or delegate some patient care task to the licensed practical nurse (LPN) and unlicensed assistive personnel (UAP). According to Cherry & Jacobs (2014), when the primary nurse/RN is off duty patient care is provided by an associate nurse who follows the care plan established by the RN. Should any problem, complication, or change in the patient’s plan of care arise while the RN (who has a 24-hour responsibility) is off duty, the nurse in charge must report those changes to the primary nurse. The RN using the primary nursing model of care must be able to maintain clear communication with all team members to include: the patient, patient’s family, associate nurse, physician, and all other health care team members. The primary nursing health care delivery model is best used in long term care settings where patients require care for an extended period of time such as hospice and home health nursing.
“In the functional nursing health care delivery model staff members are assigned to complete certain task for a group of patients” (Cherry & Jacobs, 2014). According to Cherry & Jacobs” (2014), an example of functional nursing would be when the RN performs all assessments and care planning, and administers all intravenous medications; the LPN gives all oral medications; and the UAP performs all hygiene task and takes vital signs. The charge nurse who is usually the RN makes the assignment for staff members and coordinates all patient care. “Although the functional nursing model is considered efficient and economical, the patient is treated by many caregivers who are not able to provide personalized care because they focus on performing a task and not on meeting patient needs” (Cherry & Jacobs, 2014). The functional nursing health care delivery model is appropriate for care settings such as the operating room.
“The total care health care delivery model is where all nurses are responsible for planning, organizing, and performing all care to include: personal hygiene, medication administration, treatments, emotional support, and education required for their assigned group of patients during their assigned shift” (Cherry & Jacobs, 2014). According to Cherry & Jacobs (2014), the total patient care method is commonly used in hospital’s critical care areas, such as intensive care and post anesthesia units, where continuous assessment and a high degree of clinical expertise are required at all times. Total care health care delivery models are used less in other patient care settings because health care facilities focus more on efficient, interprofessional team approaches to patient care. “Such team approaches that allow the RNs to concentrate on all aspects of care essential to good patient outcomes” (Cherry & Jacobs, 2014).
According to Cherry & Jacobs (2014), case management is a method of care delivery in which an RN case manager coordinates the patient’s care throughout the course of their illness. “Nurse case managers actively participate with their patients to identify and facilitate options and services, providing and coordinating comprehensive care to meet patient-client health needs, with goals of decreasing duplication of care, and enhancing quality cost-effective patient outcomes” (Cherry & Jacobs, 2014). The case management health care delivery model is basically used to maintain quality care while streaming cost. The health care facility and the patient benefit from the case management health care delivery model.
Health Care Delivery Model Used at Mizell Memorial
Mizell Memorial Hospital is an acute care hospital that uses the functional nursing health care delivery model (Mizell Memorial Hospital, 2015). This means their operation of nursing care is managed by a charge nurse who makes all assignments and coordinates all care. Under the charge nurse’s supervision is usually an RN, LPN, and UAP. As mentioned earlier the RN performs all assessments and care planning, and administers all intravenous medications. The LPN gives all oral medications and the UAP performs all hygiene task and takes vital signs. Staff using the functional nursing care delivery model focus on task assignments rather all patient needs.
Role of the Case Manager at Mizell Memorial
At Mizell Memorial Hospital the case manager is responsible for reviewing all inpatient charts and records. The role of the case manager is responsible for assuring that all patients on the medical surgical, intensive care, and geriatric-psychiatric unit are receiving treatment based on their diagnosis. The case manager must also set up all post hospital care to include: physical therapy, nursing home and home health placement. Lastly the case manager must be familiar with insurance regulations and Centers for Medicaid and Medicare regulations. This allows the case manager to assure that the patient is receiving the proper treatment for their diagnosis. The case management by the case manager ensures the hospital gets reimbursed for all treatments render to patients, thus making case management beneficial to the medical facility.
In conclusion, health care delivery models can be very beneficial to health care facilities when used in the appropriate health care setting. There are several different health care delivery models to fit the many different health care settings. It is best to use team nursing in inpatient and outpatient setting as these are area where there tend to be a small group of patients that require individualized care. Functional nursing is used best in the operating room where the care is more task focused. Primary nursing would yield the best results in long term care setting where patients require nursing care for an extended period of time. Total care nursing provides the best outcome when used in critical care areas allowing one person to provide and focus on all patient needs resulting in less errors. Case Management is beneficial to all nursing facilities as it improves patient outcomes and ensures facility reimbursement for services provided. The main focus of the different health care delivery systems is to assure safe, quality, cost-effective care is being provided in all health care facilities.

Reference
Cherry, B. & Jacobs, S. (2014). Contemporary nursing: issues, trends, and management. (6th ed). St. Louis, Mo. Mosby/Elsevier.
Mizell Memorial Hospital. (2015). We are mizell memorial hospital. Retrieved from: http://www.mizellmh.com/getpage.php?name=index