CNS development of health maintenance programs: quality improvement and cost reduction.

Several outpatient health maintenance programs were developed by CNSs that resulted in quality improvement and cost savings. Common implementation strategies, barriers to implementation, marketing issues and techniques, and revenue generation issues were found. An outpatient consultation model was used to expand enterostomal therapy and diabetic teaching services. Education and support programs include a cardiac support group and community education classes on aging. Preadmission programs include physical therapy consultation for patients scheduled for elective orthopedic surgery. Outpatient programs facilitate continuity of care in a managed care format, promote cost savings, and provide unique services that encourage patients to return to our hospital, thereby increasing market share. Key barriers encountered include inconsistent or ambiguous administrative support, budgetary constraints, lack of collaboration, communication problems, facility limitations, funding considerations, resource allocation, and territoriality. The programs are consistent with the change in focus of health care from treatment to prevention.

Strategic planning: the practical vision.

During the first planning year, 29 tactics were identified in a 5-year plan. Two 90-day victory calendars in that year resulted in 17 of 29 tactics being successfully implemented. During this time, strong momentum and eagerness to have successful change was evidenced. The second planning year resulted in 30 revised and/or new tactics. Midway into the second year, 6 of 30 tactics have been completed. the overall number of completed tactics was dependent upon factors such as complexity of the tactic, degree of management turnover, and operational priorities. The overall numbers of completed tactics are not as significant as the process itself, which provides mechanisms to quantify and identify quality nursing care. As a result, the nursing environment is perceived, both internally and externally, to demonstrate a nursing environment of excellence. Currently, a third annual strategic planning conference is being developed. We are confident that a planning process is in place that provides for a strong future as we continue to strive for achievement of our vision.