Category Archives: Health care delivery system
Julie A. Fairman, PhD, RN, FAAN, is Nightingale Professor of Nursing at the University of Pennsylvania School of Nursing, and director of the Barbara Bates Center for the Study of the History of Nursing. She is a predoctoral fellow at the Penn Nursing Center for Health Outcomes and Policy Research and recipient of an RWJF Investigator Award in Health Policy Research. Safiyyah Okoye, BSN, RN, and Jill Vanek, BSN, MSN, are students at the University of Pennsylvania School of Nursing.
The 2011 Institute of Medicine (IOM) report “Future of Nursing: Leading Change, Advancing Health” pointed out that because nursing scope of practice regulations vary across states, and because there is little rationale for these variations, the federal government, through the Federal Trade Commission (FTC) and the Antitrust Division of the Department of Justice, “is well situated to promote effective reforms [related to regulation of APRN scope of practice] by collecting and disseminating best practices from across the country and incentivizing their adoption.”
The IOM recommended that the FTC and the Department of Justice review existing and proposed state regulations related to advanced practice registered nurses (APRNs) to identify those that limit competition without contributing to the health and safety of the public, and urge such states to allow APRNs to provide care to patients in all circumstances in which they are qualified to do so.
Created in 1914 to promote consumer protection by eliminating and preventing anticompetitive, unsafe, or deceptive business practices, the FTC is the logical agency to address scope of practice laws. The FTC’s responsibility is to promote competition, inform consumer choice, and protect consumer safety. All are directly related to APRN scope of practice regulations, including those mandating physician supervision and oversight of APRNs when there is not “a compelling consumer protection rationale” for doing so. That includes evidence justifying restrictions on APRNs’ ability to provide health care services that could override the public interests with regard to choice, cost or competition.
Elliott Fisher, MD, MPH, a health policy researcher and alumnus of the Robert Wood Johnson Foundation Clinical Scholars program (1983-1985), was recently named director of the Dartmouth Institute for Health Policy & Clinical Practice. Fisher coined the term “Accountable Care Organization” (ACO). In this Clinical Scholar Health Policy podcast, he discusses the origins of ACOs and the effort to develop them in the nation’s health care system. Watch his interview with RWJF Clinical Scholar Chileshe Nkonde-Price, MD, (2012-2014). The video is republished with permission from the Leonard Davis Institute.
This blog post offers perspectives from seven Robert Wood Johnson Foundation Nurse Faculty Scholars who attended TEDMED 2013 last week.
Seeing things in new and different ways will advance nursing practice, research, and education. We need to think of creative strategies to raze perceived boundaries. One way for nurses to enter new frontiers is to engage in interprofessional dialogue with consumers, health care providers, researchers, entrepreneurs, technology experts, designers, and artists. We experienced this interchange at TEDMED 2013—an interprofessional conference for sharing and exploring solutions to health care’s most pressing challenges.
Collaboration is Key
Adejoke Ayoola: The opportunities to explore new advances in technology and interact with innovators remind me of an African Proverb, “If you want to go fast, go alone; if you want to go far, go together.” The outcome is more fulfilling with collaboration. By collaborating with stakeholders (e.g., community residents, community health workers, local agencies), research not only becomes more effective, it becomes more relevant to societal needs. Collaboration with my nursing colleagues promotes scholarly growth and may involve writing manuscripts or conducting smaller studies associated with a bigger study.
This is part of a series introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio.
What policies optimize nurses' role in solving the shortage of primary care practitioners? What approaches will promote and incentivize interprofessional education and practice in health care so as to improve the quality and safety of care? What promising state and federal initiatives are likely to achieve the Institute of Medicine's recommendation to increase the proportion of nurses who hold a baccalaureate or higher degree to 80 percent by the year 2020?
These and other crucial issues confronting nursing and the health care system are the focus of the Robert Wood Johnson Foundation (RWJF) Charting Nursing’s Future policy briefs. Launched in 2005, the series now includes 20 briefs covering a range of topics, including:
- Unlocking the potential of school nursing;
- Expanding the nation’s capacity to educate nurses through state-level partnerships;
- Improving the recruitment and retention of older and experienced nurses as a way to stem the looming nursing shortage;
- Understanding the relationships among such issues as access, cost, payment systems, and quality of care;
- Optimizing nurses’ role in closing the health care quality and safety “gap”;
- Addressing the nurse faculty shortage through public and private partnerships;
- Strengthening public health nursing;
- Driving policy change with data collected and analyzed by state nursing workforce centers;
- Easing the nursing shortage through government, school and employer collaborations; and more.
The award-winning documentary, Escape Fire: The Fight to Rescue American Healthcare, will premiere on CNN this evening at 8 p.m. EST, and again at 11 p.m. EST.
Through the real-life experiences of physicians and patients, the film “reveals flaws in the notion that the healthcare delivered via America’s patchwork of facilities, practitioners, and insurers offers good value for its outcomes,” according to a CNN news release. It shows the pressures providers face, and the frustrations of patients that are often exacerbated by insufficient care.
The film also offers features innovative solutions from noted leaders in the public and private sectors.
Following the broadcast, CNN chief medical correspondent Sanjay Gupta, MD will moderate a 30-minute discussion exploring how Americans can increase their access to health care and save money.
The New York Academy of Medicine is the National Program Office for the Robert Wood Johnson Foundation Health & Society Scholars program, which works to reduce population health disparities and improve the health of all Americans. The New York Academy recently conducted a survey of 17 thought leaders* in primary care and population health. In the first of five blog posts, we share a synthesis of what those leaders had to say. All quotes are printed with permission.
Defining Population Health: Many discussants cited the definition of population health developed by David Kindig, MD, PhD, as a reference point: “health outcomes of a group of individuals, including the distribution of such outcomes within the group.” Regardless of specific vantage point, there was a generally shared sentiment that population health should be thought of broadly and in common terms by a range of clinical and non-clinical stakeholders.
More discussants described a baseline framework of a clinical delivery system oriented around patients in a practice, in contrast with a public health system oriented around geographic communities. A more clinical, or “population medicine,” perspective often centered around evidence-based interventions and disease management categories so as to triage and allocate health care resources in a cost-effective manner.
Carole Pratt, DDS, is an alumna of the Robert Wood Johnson Foundation (RWJF) Health Policy Fellows program, where she worked in the office of Senator John D. Rockefeller (D-WV). Pratt was a practicing dentist in rural southwest Virginia for 32 years. This post is part of the "Health Care in 2013" series.
The Times Square ball has dropped, crisp new calendars have been affixed to office walls, and clean new agenda pages gape at us from computer screens, signaling prudent resolution makers that it is time to get serious about 2013. February 10 will mark another New Year, the beginning of the Chinese New Year festival ushering in the Year of the Snake. Parades will be held, people around the world will celebrate, and for a time at least, inherent fear of reptiles will be set aside.
In a century-long history that is somewhat convoluted, the American medical profession has come to be represented by the winged staff and serpent symbol, the Caduceus. So during 2013, the Year of the Snake, it may be no coincidence that things are looking up for the health care profession and the health of the nation in general. In its 2013 annual ranking, U.S. News & World Report announced the top ten most attractive jobs based on factors such as opportunity for employment, salary, work-life balance, and job security. Six of the top ten spots were claimed by jobs in health care.
The Robert Wood Johnson Foundation (RWJF) Human Capital Blog published more than 350 posts in 2012. On Friday, we shared five of the ten most-read posts published on this blog in 2012. Today, as we prepare to usher in a new year, we report on the top five.
Isolation in America: Does Living Alone Mean Being Alone? In this provocative piece, Eric Klinenberg, PhD, recipient of an RWJF Investigator Award in Health Policy Research, discussed his well-reviewed book, “Going Solo: The Extraordinary Rise and Surprising Appeal of Living Alone.” It looks at the health problems associated with social isolation. Klinenberg calls the increase in people living alone the country’s “biggest demographic change since the baby boom.” His post attracted the biggest audience on this blog in 2012.
Supreme Court Ruling Offers a Sense of Hope. This very personal piece by Thomas Tsang, MD, FACP, an alumnus of the RWJF Health Policy Fellows program, was the second most-read post on this blog in all of 2012. Tsang reacted to the U.S. Supreme Court ruling upholding key elements of the Affordable Care Act from the perspective of immigrant families like his own. Tsang said he hoped the ruling would allow “the country [to] start healing together and work on finding better solutions for future generations who believe that life is indeed better here in America—as my parents and I still do.”
Legal Experts Were Completely Stunned by John Roberts’ Health Care Opinion. This post by RWJF Investigator Mark Hall, JD, also addressed the U.S. Supreme Court’s health reform ruling. “We all knew it would be close, but we never saw this coming,” he blogged about the Chief Justice’s vote to uphold the highly controversial individual mandate. It was the third most-read post on the RWJF Human Capital Blog in 2012.
The Robert Wood Johnson Foundation (RWJF) Human Capital Blog published more than 350 posts in 2012. Which ones were your favorites? Today and on Monday, with the year coming to an end, we’re taking a second look at the posts on this blog that attracted the most traffic this year.
A Dream Comes True: A Single Mom with Five Kids Becomes a Nurse. Christy O’Keefe, RN, made the leap from hospital administrative staff to emergency room nurse with help from the RWJF Jobs to Careers program. In the sixth most-read post published on this blog in 2012, she shares the experience, talking about overcoming doubt and what her career means to her and her family.
New Careers in Nursing: A Whole New Direction. Karen Jennings, MS, RN, PMHNP-BC, was well on her way to earning a PhD in clinical psychology. But while working at McLean Hospital, she noticed the impact nurses had on patients, providing medical knowledge and advanced clinical skills as well as comfort and security. It was then that Jennings changed course, becoming a nurse with support from New Careers in Nursing, a program of RWJF and the American Association of Colleges of Nursing. Her account was the seventh most-read post published on the RWJF Human Capital Blog in 2012.
Nursing Needs All Hands on Deck, Including the Quiet Leadership of Introverts. When Jennifer Doering, PhD, RN, joined the RWJF Nurse Faculty Scholars program, she wondered and worried about whether an introvert could be the kind of effective nurse leader that patients, the health care system and the country need. After reading and pondering, she concluded that “introverted leadership” is not a contradiction in terms. Read more in the eighth most-read post on this blog in 2012.