The Role of Patient-Centered Care in Long-Term Care

Long-term care (LTC) is amongst the most complex facilities in healthcare that aims to provide patient-centered care through many forms of medicine and support services. It is, therefore, a continuum of long-term social and medical services as well as the accruing support to the people living with or at risk of chronic health conditions and those facing inadequate housing. In this way, the evaluation of its goals is overly difficult and complicated as compared to acute care setting. The long-term care services can, however, be classified into institutional/nursing home care, informal home care, and community care.

Business Practices

Among the factors influencing patient-centered care in healthcare organizations include business practices, regulatory requirements, and reimbursements. These complicates healthcare institutions’ settings since they are required to provide care services in adherence to business dynamics and regulatory stipulations (Bärnighausen & Sauerborn, 2002). Therefore in consideration of the challenges facing healthcare establishments in the delivery of patient-centered care, an evaluation of the various business dynamics and multifaceted settings of the firm is important. Moreover, healthcare organizations operate as business entities and as such are obliged to adhere to the objectives, goals and prevailing business dynamics in the market. The Center for Medicare Services (CMS) has revised its regulatory frameworks towards long-term facilities, in a bid to drive healthcare quality, patient safety and patient-centered care. For instance, as of November 28, 2016, the arbitration contracts had been disallowed in an attempt to protect family and patient rights.

Evidently, the care venture entities should consider industry trends, benefits, costs and profits in providing their medical services. Often, the parametric dynamics and business interests overtake the essential roles in the provision of patient-centered care services. For instance, a majority of long-term care centers evaluate the feasibility of offering services through consideration of costs, facilities, workforce requirements and other parameters such as financial costs. This hinges the effectiveness of services in patient-centered care on cost-benefit analyses since health providers need to actualize their business interests in the provision of the services (Chin, 2015). Therefore, healthcare providers are only fully committed to the profitable and sustainable provision of quality services.

Furthermore, regulatory requirements impact healthcare organizations providing patient-centered care such as long-term care directly since they provide a guiding blueprint for the accomplishment of care services. In essence, the organizations operate in adherence to the provided guidelines, and therefore they cannot act autonomously in offering care services to the society. However, the setting of unnecessary regulations by regulatory bodies could hinder the organizational endeavors to provide quality patient-centered care. Therefore, healthcare firms are obligated to develop internal mechanisms aimed at meeting the expectations in patient-centered care and the required legal guidelines simultaneously. Patient satisfaction can also be improved through regulatory transparency mandates. To promote the making of informed decisions by the general public, the famous Sunshine rules have been expanded by the Affordable Care Act (ACA) thus requiring information about institutions and healthcare providers to be reported to CMS for viewing by the public.

Also, reimbursement is a critical factor in patient-centric care which influences service delivery in many institutions providing medical care. In effect, the occurrence of mishaps during care and treatment procedures requires the healthcare organizations to reimburse the particular family or patient a sum of money in damages (Hassenteufel & Palier, 2007). Such realities put healthcare provision entities at odds through undermining their likelihood of offering patient-centered care as a result of the damage costs associated. Evidently, this regulation prioritizes safety reinforcements and as such, healthcare-acquired conditions are laden upon the institution's financial responsibility. As a result, the control will lead facilities towards attentiveness to safety, prevention of unusual occurrences and sentinel events which lead to patient injury. Furthermore, the reinforcement of penalties to facilities by the ACA as a result of re-admissions and high incidences as well as looking into the re-admission costs for patients long-term care is a bonus to these safety efforts.

The reality of reimbursement is somewhat painful for many organizations due to the accrued massive losses that may shake an institution’s business aspect resulting in the eventual closure of the venture. Furthermore, provided that the care services cease to be profitable, the financial goals are undermined leading to a reluctance of the healthcare organizations to offer the best services (Hassenteufel & Palier, 2007). In this way, the quest for optimal patient-centered care is hindered by several associated factors which either promote unprofitability or complicate the care processes. Overall, the commercial sustainability and profitability of healthcare organizations in offering care should be upheld.

Setting Description

The Patient-and-Family-Centered-Care (PFCC) is a long-term care center that was designed countrywide. The facility provides wide-ranging services including sub-acute care, long-term care and also rehabilitation related services. The facility also addresses the non-medical and medical needs of patients with chronic illnesses and disabilities. Although a majority of clients are elderly, some few others are considerably younger. Moreover, there is cultural diversity in the population receiving care services. Currently, census reports indicate that clients proportions are 60% Caucasian, 10% Asian, 12% African American, 8% Middle Eastern and 9% Hispanic. The services offered by the long-term care involves interdisciplinary teams of physicians and medical directors who have different privileges to clients’ care in the long-term care (LTC). The LTC facility, founded in 1964, offers a 230-bed capacity, a 24 hours nursing care and a 1:10 nurse-patient ratio. Among their interdisciplinary care providers including pharmacists, physicians, nurses, rehab therapists, social worker, dietitians and activities' coordinators. Also, case management is availed to patients receiving sub-acute care after acute illnesses or following surgery. Additionally, radiology and laboratory services are also available from collaborating external entities. The facility teams are therefore equipped to provide social and medical services as well as the requisite care for clients and their close family members.

Strengths and Weaknesses

The LTC center is committed to the provision of patient-centered care as evidenced by their goals and mission statement. The facility stipulates that their core goal is to excellently serve the clients/families in a bid to maintain optimal quality of life and desired levels of patients’ well-being. Also, there is an explicit expectation of accountability for staff members in the provision of patient-centered care which is a definite quality attribute of the facility. As described in their job description, the staff are encouraged to demonstrate a strong commitment to patient-centered care in the facility. Furthermore, performance appraisals are utilized to reiterate the commitment to family and patient-centered care. Also, there are quarterly meetings among staff aimed at discussing the strategies, goals and potential difficulties. However, not all disciplines are always represented in these meetings. For instance, there is a rare representation of physicians at the meetings. This phenomenon creates a disconnect between the multidisciplinary teams which can harm effective communication and delivery of care.

Another evident weakness is the lack of representation in the activities of the governing board of the patients and family members. This limits the apparent inclusion of family members and patients in the guidelines and program development as well as in policy making. However, there is an explicit strength of the facility through its mission statement which demonstrates a commitment of service to the society. In this way, a client is entitled to a copy of the patient’s bill of rights that is tailored for easy understanding. This fosters a trustful relationship between the client and the organization since the patient is fully aware of his/her rights. Another weakness is the inadequate participation in safety and quality rounds and the non-representation of patients or family members in the advisory council. This is, however, being addressed through the recent creation of the resident council meetings by the LTC. These forums present opportunities for social workers and residents to voice concerns. Afterward, the social worker raises the concerns at the staff meetings for discussion. The feedback and follow through is however of great interest among the residents and the staff despite the positive efforts by these type of meetings.

For example, some clients have voiced concerns regarding the costs of new medications. Several clients were presented with new medications unknowingly or without adequate explanation by the dispensing nurses. Others complained of the costs of laboratory studies and the lack of a comprehensive dialogue with the nurse or physician regarding the results. Furthermore, since the meetings are not mandatory for the staff, the attendance is considerably low which leads to a communication disconnect between the staff and clients. This is because the poorly attended meetings are not efficient avenues to share families and clients’ concerns. Also, although the client base is diverse, no careful concern is expressed in the measurement and collection of data on ethnicity, language and race of the patients served in the facility.

Also, the family/patient lacks immediate access to the client’s medical records. To get these records, a person must fill a form and pay a small fee per requested page. This poses a barrier to families/patients in the active engagement in the healthcare. Additionally, the LTC facility lacks specific resource web portals for families/patients. For instance, specific web portals could be designed for patients and family members such that they can quickly retrieve simple information on management of diseases and chronic conditions such as diabetes and heart disease. The shortcoming is further compounded by the lack of resource computers and rooms for utilization in information acquisition on the management of conditions and illnesses.

The facility holds care-plan meetings every 3 months among its LTC residents and every month for the clients of sub-acute care. Such meetings ensure that the multidisciplinary teams listen to and treats clients as partners which is beneficial to both the families/clients and also the staff. It also presents an opportunity for review of medication lists, discussion of goals and reinforcement of partnership. Therefore, communication between interdisciplinary teams and the clients can be improved significantly according to the PFCC assessment tool.

One Area of Improvement and Strategy

Among the significant shortcomings of the patient-centered care delivery in this LTC facility is the inefficient communication among healthcare coordinators such as the family/patients, nurses and others. In essence, the ineffectiveness of healthcare services can be attributed to the inadequate interaction among the various interdisciplinary team members and the families/patients. To improve on this shortcoming, the facility should allow external advisory input from families/patients. This should be done through the inclusion of families and patients in safety and quality rounds. Furthermore, due to the active role of the facility as a new home for the patients, the clients’ inputs should be an integral part of program and operation guide. They should also be included in the advisory council. This calls for a cultural change in the facility to include patients in the sharing of information. Evidently, the inclusion of patients in the clinical microsystem enhances safety measures since concerns will be reported easily and addressed.

Resource rooms and web resources such as computers should be availed for the empowerment of the families and patients to ensure speedy identification and recognition of sentinel events before they escalate. They should, however, be sensitive to literacy levels and language for maximum impacts. The resources also make patients feel as active members as opposed to mere recipients of care which enhances the likelihood of reporting concerns. Additionally, improved communication through inclusion in medical rounds with nurses and physicians can act as a useful quality improvement task. For instance, laptops can be used in the immediate writing and review of orders with the client. To minimize errors and miscommunication, family/patient may repeat the order aloud. Moreover, the physical designs of operations and facilities may include patients/families to increase the level of communication and participation and increase client satisfaction as well as medical errors.

Also, new staff and personnel should be introduced to family/patient. This improves patient/family-centered care through the facilitation of open communication, collaborative culture as well as the orientation of new staff members. These improvements to counter prevailing weaknesses can only be realized through the establishment of strategic multifaceted communication that facilitates efficient and timely communication for the improvement of patient-centeredness in healthcare facilities (White, 2015). In effect, these reforms are aimed at bridging the gaps among healthcare coordinators, patients/family, and staff as well as improving their interpersonal communication levels.

The Use of Change Theory in the Establishment of the Strategy to Solve the Communication Weaknesses

The Lewin’s change theory will be very crucial for utilization in the endeavors to improve patient-centered care by the staff. In its initial stage, the staff members must recognize the existence of a problem. Furthermore, a self-assessed review of the family/patient-centered care serves as an essential tool in the realization of the need for change. The eventual unfreezing dawns through the recognition of research and evidence that supports the inclusion of family/patient as engaged, active members of the current healthcare team. Consequently, these strategic implementations have to be innate to the healthcare culture when dealing with patients as well as their families. The unfreeze, change and refreeze model will eventually be useful in the LTC setting. Therefore, the care team members have to relinquish a passive treatment of patients and embrace their active role in the current healthcare structures.

Moreover, the establishment of a multifaceted strategy will be facilitated through the Lewin's change theory. The application of this theoretical perspective encourages a heightened desire for meaningful change in the organizational culture of care facilities. This is because the change theory emphasizes the bringing about of change through planning, participation, and evaluation of particular settings (Hassenteufel & Palier, 2007). Therefore, I will strive to apply the Lewin’s theory of change to solve the manifest weaknesses through the use of a multifaceted communication strategy.

The Financial Implications of Implementing the Strategy

The cost of implementing the proposed policy will be relatively cheaper due to the availability of required structures and facilities in the care facilities. It is, therefore, a feasible policy which can be afforded without much financial strain. Major costs are expected in the establishment of resource rooms and web resources and making them available to families/patients. Also, the regular outsourcing of contracts for conduction of unbiased patients’ satisfaction surveys will incur a considerable cost. Other costs expected include the education, training and materials’ provision to patients/families as well as the staff members. A cost-benefit analysis would most likely indicate higher gains than costs, and as such, the healthcare organizations involved in the implementation of the strategies will find them profitable and sustainable (St Sauver, Warner & Yawn, 2013). Therefore, the strategy will not only improve the communication in LTC settings but also provide profitable financial implications to the healthcare organization thus ensuring high-quality patient-centered healthcare in the facility.

The Methods Used to Evaluate the Effectiveness of the Strategy

In the assessment of the success and the strategic efficiency of the policy, a comprehensive mechanism of evaluation will be used. The statistical reductions in the number of sentinel events and medical errors can be assessed by a quality assurance team after 3-6 months and regularly after that, following the adoption of strategies in planning and communication. To increase the chances for success, a separate analysis of individual stages, actions and processes should be utilized throughout the implementation process. Furthermore, there will be monitoring of the utilization of the web resources and resource rooms including the gathering of feedback on ease of access through interviewing of clients. Inquests into patient satisfaction can also be used to assess the impacts of the changes and the feelings of patients/families towards the care. To minimize biases in the formulation of survey questions an external contractor will be used. In other words, before proceeding to subsequent stages, the phases will be independently evaluated, gaps identified and corrected through a systematic evaluation program.

Creation of a Multidisciplinary Team

The composition of the multidisciplinary team will be five members of diverse backgrounds regarding experiences and skills. More importantly, the five members will be tasked with different roles which they will play in their contribution to the efficient improvement of the strategic implementation procedures. The five positions which will be allocated to respective members and define their roles in the team include a nurse manager, a social worker, physician, relations officer and a pharmacist (White, 2015). These roles will dictate the assigned specifications defined under the categories.

Therefore, the physician will be tasked with clients’ enlightenment about the prescriptions and medical diagnoses in relation to every diagnosis. They will also engage exhaustively with the clients to ensure that they clearly understand the respective disorders and are consequently involved in the planning for care. Also, an explanation of the roles of the particular members of the interdisciplinary team is provided to the patient by the physician to foster understanding of their importance in the care plan and prevent disconnect and negative attitudes in clients. The nurse manager, on the other hand, will ensure that the responsibility of patient education is executed by the nursing staff in line with the patients’ needs. This address to knowledge deficits about illnesses serves to decrease patients’ anxiety levels. For instance, the nurses need to educate and communicate post-procedure and pre-procedure steps to patients clients facing such procedures to foster better preparation and improved patient outcomes. More information can after that be sought by the clients from the internet facilities and resource centers. To further increase the active involvement and value of the client in the system, additional teachings on the non-modifiable and modifiable changes in lifestyle should be extended to the patient.

The pharmacists are to provide interaction and medication updates to nurses as well as the physicians and patients/families. This helps patients to make better-informed decisions while helping them to understand the significance of the prescribed treatments and medications. Furthermore, the availability of such communication with the patient helps in healthcare planning since the client can discuss concerns and take a decision on opting for the medication or not. The social worker has the sole responsibility of follow-up on patient satisfaction with availed care and involves patients’ relations specialist in the case of egregious concerns from the clients. Also, the patient survey delivery falls under the jurisdiction of the social worker and can be delivered in a hard or soft copy. The mediation role in the event of a patient’s feeling of immediate change or compromised communication is the role of the relations specialist. Remarkably, cultural competency is critical in addressing the factor of cultural diversity in such patient-centered care.

Cultural Diversity of the Team

Workplace diversity is crucial to the success of the strategy. The acknowledgment and embrace of differences among healthcare organizers and interdisciplinary teams is a substantial contributor to this effect. Evidently, the current cultural census report in this LTC facility indicates that 8% are Middle Eastern, 9% Hispanic, 10% Asian, 12% African American and 60% are Caucasian. An attempt by the culturally diverse staff to desist from dismissing or trying to change population from these backgrounds is preferred through an embrace of differences. This improves employees’ understanding and better teamwork which creates a better work environment. A culturally sensitive team is therefore essential in incorporating inclusion and appreciating similarities as opposed to exclusion leading to increased productivity and inspiration to the team. This feeling spills over to the clients who end up feeling valued and motivated. Moreover, the sensitivity and competency to cultural diversity reduce healthcare disparities through fairness, inclusion, respect, and understanding of the particular needs of the family/patient in the provision of high-quality care. This practice, therefore, improves the overall patient-centered care. Furthermore, the approach provides an excellent trendy business model that is in line with legal responsibilities and prevailing changes in the demographics of healthcare settings in a rapidly globalizing world.

Transformational Theory

A transformational form of leadership offers the best route for identifying avenues for change, collaboration and embarking on implementing the change and as such I will utilize the platform in developing an agenda for my team. The team will, therefore, aid in developing an operational framework and also will be tasked with the improvement and success of the patient-centered care through implementation of change in the facility (St Sauver, Warner & Yawn, 2013). Moreover, I will strive to inspire my team members towards detection of the desired change and development of a vision that will directly inspire a progressive transformational process.

This theory will also enable the implementation of the initiatives for change where the members are expected to act in collaboration with important stakeholders. This cooperation of the team through the implementation phase of the strategy will provide a comprehensive framework for solving weaknesses in coordination as well as poor communication in the healthcare program. In fact, the members will first evaluate the occurrence of poor communication and coordination in care settings by conducting a study (Hassenteufel & Palier, 2007). After that, the members will assess the effects of the deficiency on the delivery of high-quality patient-centered care. The team will then institute the strategic implementations in the healthcare setting in collaboration with the members of staff. Additionally, the utilization of self-reflection is an important reflection method and will, therefore, be duly considered in fostering success for the lineup. On the whole, the team members will also be required to be skilled to ensure successful steering of the current program.

Implementation of Strategy

As mentioned earlier, patients/families should be slotted into the hospital committees and included in the regular meetings. Interested clients can be appointed on a voluntary basis or democratically voted in by the patient/family population. The selected members should also be allowed to serve on the quality assurance team to include their perspective on the safety needs of the patients. Also, in the conduction of the meetings, proper documentation of the input should be done, and the subsequent follow-up meetings held. This serves as an additional strategy to include the family/patient voice in improving long-term care.

Additionally, daily rounds can be utilized to initiate dialogue on the effectiveness of the care provided. To foster inclusion further, patients can be consulted in the recruitment of new staff to set the tone for a culture of change towards patient-centered care. Another strategy includes the provision of senior leaders with the necessary education and information to sharpen their knowledge in patient-centered care. A strategic open forum discourse between the administrator or nurse manager and the families/patients can also be used as a platform to share healthcare experiences as well as provide recommendations for resource rooms’ physical design from the stakeholders. Also, goals and priorities can be formulated and regularly monitored through non-formal and formal leadership.

An action plan should, therefore, be prepared and presented to the owners and administrators for improvement of patient care. In the action plan, the strategies of improving inclusion, communication, support, and education will be outlined. Evidence gathered from research, and clinical studies should be presented alongside to exemplify the success potentials of the proposed action plan. The stakeholders’ satisfaction will regularly be evaluated throughout the implementation process and documentation provided to demonstrate the occurrence of change. The organization can also preview surveys for the staff as well as patients’ satisfaction surveys. Moreover, the owners and administrators will review samples of websites and educational resources that are cost-effective and user-friendly. Finally, an evaluation report on the effectiveness of the strategy will be prepared after three months and presented to the owners and administrators.

Tools for the Team

The availability of the Self-assessment tool from the Institute for Healthcare Improvement (IHI) can be beneficial to the LTC facility. This is because it can be utilized in six crucial areas. These include resources, leadership for improvement, workforce, results, human resources, data management, and infrastructure as well as in improving competence and knowledge. Apart from these improvement efforts, the tool can also be utilized in the discussion on the weaknesses and strengths within the facility. The tool will therefore assist in the organizational reflection on the capability levels of the six areas highlighted. These include just beginning level, developing level, making progress, significant impact and the exemplary level. In this way, the current standing at every level of achievement can be evaluated through this tool for improved long-term care in the facility.

Conclusion

In conclusion, LTC is a complex system in healthcare that is set apart from other business settings by the regulatory demands, quality indicators, and unique economic nature. These factors consequently challenge the optimal attainment of goals in patient-centered care. Of greater importance among the interdisciplinary teams is the creation of credible healthcare leadership through improvement of communication skills. This creates the capacity to overcome obstacles that tend to undermine the success of care facilities. Moreover, the PFCC tool helps to unearth the weakness factors affecting the implementation of improvement strategies such as communication. Accordingly, a targeted application of multifaceted communication models should be developed to overcome the issue through improved correspondence between caregivers and patients. As such, an inclusive team was formed to spearhead the policy implementation which comprised of members from diverse professional and cultural backgrounds. Primarily, each member offered a role-based contribution to the success of the strategy which promises better implementation of the program for proper communication and coordination of patient-centered care.

References

Bärnighausen, T. & Sauerborn, R. (May 2002). One hundred and eighteen years of the German health insurance system: Are there any lessons for middle- and low-income countries? Social Science & Medicine, 54(10), 1559–1587. Retrieved from doi:10.1016/S0277-9536(01)00137- X. PMID 12061488.

Chin, R. (2015). Examining teamwork and leadership in the fields of public administration, leadership, and management. Team Performance Management, 21(3/4), 199-216. Retrieved from doi:10.1108/TPM-07-2014-0037.

Hassenteufel, P. & Palier, B. (2007). Towards neo-Bismarckian health care states? Comparing health insurance reforms in Bismarckian welfare systems. Social Policy & Administration. 41(6), 574–596. doi:10.1111/j.1467-9515.2007.00573.x.

Institute for Healthcare Improvement.(n.d). IHI Improvement capability self-assessment

tool. Retrieved from http://www.ihi.org/resources/pages/tools/IHIimprovement

CapabilitySelfassessmentTool.aspx

St Sauver, J. L., Warner, D. O. &Yawn, B. P. (2013). Why patients visit their doctors: assessing the most prevalent conditions in a defined American population. Mayo Clin. Proc., 88(1), 56– 67. Retrieved from doi:10.1016/j.mayocp.2012.08.020. PMC 3564521.PMID 23274019.s

White, F. (2015). Primary health care and public health: Foundations of universal health systems. Med Princ Pract, 24(103), 103-116. Retrieved from doi:10.1159/000370197