Critical factors for optimising skill-grade-mix based on principles of Lean Management - a qualitative substudy / Erfolgskritische Faktoren bei der Optimierung des Skill-Grade-Mix auf der Basis von Lean Management-Prinzipien - eine qualitative Teilstudie

Background: Due to scarce resources in health care, staff deployment has to meet the demands. To optimise skill-grade-mix, a Swiss University Hospital initiated a project based on principles of Lean Management. The project team accompanied each participating nursing department and scientifically evaluated the results of the project. Aim: The aim of this qualitative sub-study was to identify critical success factors of this project. Method: In four focus groups, participants discussed their experience of the project. Recruitment was performed from departments assessing the impact of the project retrospectively either positive or critical. In addition, the degree of direct involvement in the project served as a distinguishing criterion. Results: While the degree of direct involvement in the project was not decisive, conflicting opinions and experiences appeared in the groups with more positive or critical project evaluation. Transparency, context and attitude proved critical for the project's success. Conclusions: Project managers should ensure transparency of the project's progress and matching of the project structure with local conditions in order to support participants in their critical or positive attitude towards the project.

In short supply: pay policy and nurse numbers

In April 2017, the House of Lords Select Committee on the Long-Term Sustainability of the NHS concluded that the biggest internal threat to the sustainability of the NHS is the lack of a comprehensive national strategy to secure the NHS and care system the workforce it needs. This briefing, and its two supplements, examines two of the most important issues in workforce policy today which pose both immediate and long-term risks to the ability of the NHS to sustain high quality care: staffing numbers and standards and the future of NHS pay policy. It highlights that the lack of a coherent workforce strategy which is integrated with funding plans and service delivery models is one of the Achilles heels of the NHS.

[Nursing care in the run-up to Swiss DRG ­ Nurses' experiences with interprofessional collaboration, leadership, work load and job satisfaction]. / Pflege im Vorfeld von SwissDRG - Erfahrungen von Pflegenden mit interprofessioneller Zusammenarbeit, Führungsverhalten, Arbeitslast und Arbeitszufriedenheit.

BACKGROUND: The literature reports critically on the consequences of the introduction of case-based hospital reimbursement systems, which hamper the delivery of professional nursing care. For this reason, we examined the characteristics of nursing service context factors (work environment factors) in acute care hospitals with regards to the introduction of the new reimbursement system in Switzerland. AIM: This qualitative study describes practice experiences of nurses in the context of the characteristics of the nursing service context factors interprofessional collaboration, leadership, workload and job satisfaction. METHODS: Twenty focus group interviews were conducted with a total of 146 nurses in five acute care hospitals. RESULTS: The results indicated that for quite some time the participants had observed an increase in complexity of nursing care and a growing invasiveness of clinical diagnostics and treatment. At the same time they noticed a decrease in patient length of stay. They strived to offer high quality nursing care even in situations where demands outweighed resources. Good interprofessional collaboration and supportive leadership contributed substantially to nurses' ability to overcome daily challenges. Job satisfaction was bolstered by interactions with patients. Also, the role played by the nursing team itself is not to be underestimated. CONCLUSIONS: From the participants' point of view, context factors harbor great potential for attaining positive patient outcomes and higher job satisfaction and have to be monitored repeatedly.

[Nursing research and the Hospital Programme for Nursing and Allied Health Research]. / Recherche infirmière et PHRIP, retour d'expérience.

Nursing research is perceived as a way of improving quality of care. As is the case in Britain and Switzerland, this ambitious activity is developing in France, favoured by the raising of nursing studies to university level and boosted by funding from the French ministry of health. A nursing team at Pitié-Salpêtrière hospital, in Paris, share their enthusiasm for this new approach.

[Opening up psychiatric care]. / Vers une ouverture des soins en psychiatrie.

The post-war phase of the deinstitutionalisation of psychiatry, which led to the legal recognition of the sector, has been followed by the years of economic crisis. As in the past, such times favour the exclusion of the weakest. As resources dwindle, only the clinical meaning, the dynamism and creativity of the nursing teams can ensure the emergence of new solutions for complex care situations.

The impact of different nursing skill mix models on patient outcomes in a respiratory care center.

BACKGROUND: Many hospitals have reformed hospital policies and changed nursing models to cope with shortages in nursing staff and control medical costs. However, the nursing skill mix model that most successfully achieves both cost effectiveness and quality care has yet to be determined. AIM: The aim of this study was to explore the impact of different nurse staffing models on patient outcomes in a respiratory care center (RCC). METHODS: Retrospective data from 2006 to 2008 were obtained from records monitoring nursing care quality, as well as patient records and nursing personnel costs in an RCC as a medical center, in southern Taiwan. A total of 487 patients were categorized into two groups according to the RCC's mix of nursing staff. The "RN/Aide" group comprised 247 patients who received RN and aide care, with a 0.7-0.8 proportion of RNs, from July 2006 to June 2007. The other 240 patients ("All-RN") received 100% RN care from January 2008 to December 2008. RESULTS: The results of this study indicated no significant differences in occurrence of pressure ulcer or respiratory tract infections, days of hospitalization, mortality, or nursing costs. However, significant differences were observed in ventilator weaning and occurrence of urinary tract and bloodstream infections. CONCLUSIONS: A higher proportion of RNs was associated not only with a lower rate of urinary tract infection but also with more patients being weaned successfully from ventilators. The findings of this study have implications for how managers and administrators manage nurse staffing in respiratory care.

[Elzach concept and intervention catalogue of nursing therapy in postacute neurological rehabilitation within the German DRG System]. / Elzacher Konzept und Leistungskatalog der therapeutischen Pflege in der neurologischen Frührehabilitation (Phase B).

The German DRG system defines specialized treatments through a set of minimal requirements, the documentation of which and its assessment by external specialists of the medical service of the statutory health insurance causing frictions between rehabilitation hospitals and the medical service. It is especially problematic to make a clear distinction between nursing care and treatment. To reduce frictions and interface problems, a catalogue of acts of therapy performed by nurses was agreed for neurological early rehabilitation in Baden-Württemberg. This Elzach concept and catalogue describe therapeutic nursing in neurological rehabilitation and increase transparency and accountability both for providers and cost carriers.

Cost implications of organizing nursing home workforce in teams.

OBJECTIVE: To estimate the costs associated with formal and self-managed daily practice teams in nursing homes. DATA SOURCES/STUDY SETTING: Medicaid cost reports for 135 nursing homes in New York State in 2006 and survey data for 6,137 direct care workers. STUDY DESIGN: A retrospective statistical analysis: We estimated hybrid cost functions that include team penetration variables. Inference was based on robust standard errors. DATA COLLECTION: Formal and self-managed team penetration (i.e., percent of staff working in a team) were calculated from survey responses. Annual variable costs, beds, case mix-adjusted days, admissions, home care visits, outpatient clinic visits, day care days, wages, and ownership were calculated from the cost reports. PRINCIPAL FINDINGS: Formal team penetration was significantly associated with costs, while self-managed teams penetration was not. Costs declined with increasing penetration up to 13 percent of formal teams, and increased above this level. Formal teams in nursing homes in the upward sloping range of the curve were more diverse, with a larger number of participating disciplines and more likely to include physicians. CONCLUSIONS: Organization of workforce in formal teams may offer nursing homes a cost-saving strategy. More research is required to understand the relationship between team composition and costs.

Cost effectiveness in leg ulcer management in the community.

Wound care and leg ulcer management account for the largest part of district nurses' workload. This has major implications on prescribing budgets of primary care groups (PCGs). Ineffective care results in an expensive waste of financial resources and poor quality care for the patients involved. Two case studies of patients with venous leg ulcers are used as an example of how practice can vary within one PCG. Continuing support and training is needed for all community nurses to enable them to meet national and local standards and guidelines.

Cost--benefit analysis of team supervision: the development of an innovative model and its application as a case study in one Finnish university hospital.

AIM: To develop a model of costs and benefits of team supervision and a formula, which are examined more closely by means of an example. BACKGROUND: The popularity of clinical supervision (CS) as one of the methods of supporting health care practitioners' professional development (formative function), coping (restorative function) and quality improvement (normative function) has increased in the 1990s. CS may take the form of one-to-one or group supervision. Team supervision is a special form of group supervision. It means a group that has an interrelated work life outside the group. A host of literature and articles is available on CS. However, the costs and benefits of CS are less examined even though these have given rise to discussion particularly among decision-makers, because the monetary benefit of CS remains unsolved. METHOD: A nominal group technique was used to develop a model of costs and benefits of team supervision and a formula was derived on the basis of the model. The existing statistical data, for example a hospital ward's annual reports, data on sick days and reports on indemnities were utilized in the application of the formula. FINDINGS AND CONCLUSION: Team supervision was efficient in economic terms on the example ward. The model and the formula constitute a first attempt to ascertain the net present benefit of team supervision. Both the model and the formula need to be further tested, specified and refined.

Disease management for chronic congestive heart failure.

The dilemma of the high cost of quality health care in a managed care environment for chronic disease populations has led to the development of a nurse-managed chronic care clinic that focuses on outpatient case management of chronic diseases beginning with chronic heart failure patients. The clinic provides advanced practice nurse management for heart failure patients in pharmacotherapy, education, counseling, dietary and lipid management, and exercise training via software management programs. The clinic is developing further management for comorbidity factors such as diabetes and chronic obstructive pulmonary disease. The history, development, and function of the clinic are reviewed.

Continuity of care by a midwife team versus routine care during pregnancy and birth: a randomised trial.

OBJECTIVE: To compare continuity of care from a midwife team with routine care from a variety of doctors and midwives. DESIGN: A stratified, randomised controlled trial. PARTICIPANTS AND SETTING: 814 women attending the antenatal clinic of a tertiary referral, university hospital. INTERVENTION: Women were randomly allocated to team care from a team of six midwives, or routine care from a variety of doctors and midwives. MAIN OUTCOME MEASURES: Antenatal, intrapartum and neonatal events; maternal satisfaction; and cost of treatment. RESULTS: 405 women were randomly allocated to team care and 409 to routine care; they delivered 385 and 386 babies, respectively. Team care women were more likely to attend antenatal classes (OR, 1.73; 95% CI, 1.23-2.42); less likely to use pethidine during labour (OR, 0.32; 95% CI, 0.22-0.46); and more likely to labour and deliver without intervention (OR, 1.73; 95% CI, 1.28-2.34). Babies of team care mothers received less neonatal resuscitation (OR, 0.59; 95% CI, 0.41-0.86), although there was no difference in Apgar scores at five minutes (OR, 0.86; 95% CI, 0.29-2.57). The stillbirth and neonatal death rate was the same for both groups of mothers with a singleton pregnancy (three deaths), but there were three deaths (birthweights of 600 g, 660 g, 1340 g) in twin pregnancies in the group receiving team care. Team care was rated better than routine care for all measures of maternal satisfaction. Team care meant a cost reduction of 4.5%. CONCLUSION: Continuity of care provided by a small team of midwives resulted in a more satisfying birth experience at less cost than routine care and fewer adverse maternal and neonatal outcomes. Although a much larger study would be required to provide adequate power to detect rare outcomes, our study found that continuity of care by a midwife team was as safe as routine care.