Nursing and the science of prevention for population health.

The topic of patient-centered care is at the very epicenter of the contemporary emphasis on a value-based approach to health care. Multiple studies confirm that positive outcomes are consistently achieved when clinicians and administrators put appropriate emphasis on patient-centered care. Although we would agree that the patient-centered approach is necessary for achieving positive clinical outcomes for individual patients, we suggest that this approach alone is insufficient to sustain these outcomes across large populations over an extended-period of time. We believe that a science-based approach to population health coupled with patient-centered care pathways will achieve the most effective, long-term impact for large groups of individuals. Furthermore, we believe that nurses play a central role in a science-based approach to patient-centered medical care. In this article, we discuss the intersection of preventative science, patient-centered care, and the role of nurses. We present our experience at Texas Health Resources with the use of clinical nurse leaders in a science-based population health approach to achieve more consistent, positive outcomes during transition of care. Finally, we suggest that care providers integrate the science of prevention with the principles of patient-centered care to more consistently deliver on the promise of population health.

The system chief nurse executive role: sign of the changing times?

As the health care system landscape continues to evolve toward more integrated care, a trend toward consolidation of hospitals into larger systems continues. The systems are more than the traditional hospital-centric structures, as acute care becomes just one component to a larger system that includes ambulatory care, acute and post-acute care, chronic disease and end-of-life management, and all structures in between. To provide leadership in these new models, there have been an increasing number of system chief nurse executives hired both to facilitate the integration of care and to align and standardize nursing practice across the continuum. By definition, the role of the system chief nurse executive differs from that of the entity chief nursing officer. A crosswalk is presented that describes the differences between the roles and reflects on the implication for system chief nurse executives during our changing times.

An aging population with chronic disease compels new delivery systems focused on new structures and practices.

Patients now, more than ever, need reassurance that they are indeed the focus of the healthcare team. Patients enter the healthcare system knowing that there are worldwide shortages of key personnel, that physicians can no longer afford malpractice coverage and are many times practicing "defensive medicine," and that there are reported issues in terms of patient safety that may affect their own care within a hospital setting. With inpatient care becoming increasingly focused on "curing" via application of new and advanced technologies, patients are beginning to ask the question "Does anyone care?" To answer that question, Baptist Hospital of Miami, part of Baptist Health South Florida, committed to the hospital-wide implementation of a new model of practice. In this model, a patient care facilitator (PCF) becomes the primary point person for the patient during their stay. Each PCF leads a "Twelve Bed Hospital," a smaller segment of the patient care center where staff work with the PCF to make the whole inpatient experience more personalized. Initial results of the pilot implementation are promising. Research is underway to assess the overall effects of this practice model on continuity of care, patient safety, satisfaction, efficiency, and effectiveness of patient care.