Measuring Capacity to Care Using Nursing Data

Evelyn Hovenga, Cherrie Lowe

• Publisher: Academic Press
• Year: 2020
• Print ISBN: 9780128169773
• eBook ISBN: 9780128169780
• Topic: Scienze biologiche
• Subtopic: Biotecnologia

Measuring Capacity to Care Using Nursing Data presents evidence-based solutions regarding the adoption of safe staffing principles and the optimum use of operational data to enable health service delivery strategies that result in improved patient and organizational outcomes. Readers will learn how to make better use of informatics to collect, share, link and process data collected operationally for the purpose of providing real-time information to decision- makers. The book discusses topics such as dynamic health care environments, health care operational inefficiencies and costly events, how to measure nursing care demand, nursing models of care, data quality and governance, and big data.

The content of the book is a valuable source for graduate students in informatics, nurses, nursing managers and several members involved in health care who are interested in learning more about the beneficial use of informatics for improving their services.

• Presents and discusses evidences from real-world case studies from multiple countries
• Provides detailed insights of health system complexity in order to improve decision- making
• Demonstrates the link between nursing data and its use for efficient and effective healthcare service management
• Discusses several limitations currently experienced and their impact on health service delivery

Chapter 1

Dynamic health care environments

Abstract

This chapter introduces and explains the concept of capacity to care in terms of healthcare environmental features from a workforce capacity perspective. Many aspects known to influence the capacity to care concerning any nation's health care system are identified. Each of these are examined to show how the workforce is likely to respond and to provide context for this publication as a whole. These aspects essentially represent resource input factors applicable to any healthcare facility relative to desired health outcomes. The frameworks adopted for this analysis are the World Health Organisation (WHO)’s Health System framework consisting of six building blocks and the WHO health framework that includes four high level goals or outcomes. The chapter concludes with a description of the contribution of the professions of nursing and midwifery to healthcare delivery and presents the case for why nursing and midwifery data needs to be at the center to achieve any nation's desired health outcomes.

Keywords

Health care; Health system framework; Patient safety; Workforce; Nurses; Nursing data; Midwifery data; Knowledge; Efficiency; Effectiveness

How is capacity to care defined?

The term “capacity” refers to one's ability to successfully undertake any type of activity to achieve a desired objective or outcome, including the ability to apply a degree of competence associated with any physical or cognitive activity. Capacity also refers to a quantity of things that can produce or deliver required objects or services. Within the healthcare service industry there is an emphasis on building workforce capacity in terms of numbers and skill mix. Capacity building may be defined as:

promoting an environment that increases the potential of individuals, organisations and communities to receive and possess knowledge and skills as well as to become qualified in planning, developing, implementing and sustaining health related activities according to changing or emerging needs [1].

Crisp et al. [2] identified four capacity building strategies, a bottom-up organizational approach, a top-down organizational approach, the use of partnerships, and a community organizing approach. In essence this is about building social capital. We're interested in measuring the nursing and midwifery capacity to care, where caring is the desired outcome measure and in building capacity among those who need to plan, develop, implement and sustain nursing and midwifery service delivery.

Caring processes may be referred to as personalization, participation and responsiveness as applied when meeting a person's health and care needs while making them feel “cared for” [3]. These three concepts were defined following extensive research by Strachan as follows:

• • Personalization is the degree to which the healthcare team gets to know the person. This includes those interpersonal behaviors that demonstrate: connecting, knowing and empathizing.
• • Participation is the degree to which the healthcare team respects the involvement of the person, and those close to them, in their healthcare. This includes those interpersonal behaviors that demonstrate: involving, goal setting and sharing decisions.
• • Responsiveness is the degree to which the healthcare team monitors and responds to the person's health & care needs. This includes those interpersonal behaviors that demonstrate: being attentive, anticipating and reciprocity.

A capacity to care requires sufficient human resources with the appropriate knowledge and skills to achieve these desired outcomes when and wherever health services are provided. Nurses and midwives are at the center. The data and information collected and used by nurses and midwives are fundamental to our ability to measure our collective capacity to care. This group of health professionals apply their scientific knowledge and skills, as members of multidisciplinary teams of health professionals, supported by lesser qualified staff within a large variety of health care environments.

Balancing the many factors contributing to any nation's health system's capacity to care is very challenging, given the continuing significant changes in the world around them such as workforce availability, technology changes and increasing service demands. Health systems and organizations need to be adaptive. Within the international medical informatics community it is an accepted fact that sustainable health systems require successful implementations of future proof digital technologies within every healthcare organization delivering services [4]. This is also required to enable us to measure our capacity to care. Sustainable information systems need to be semantically interoperable to realize operational effectiveness and efficiencies through the retention of meaning (context) despite electronic data transfers and processing. This requires the linking of data elements to standard terminologies and associated ontologies as a foundation and capability of machine processing. Semantic interoperability, and its significance in terms of resulting system functionality, potential return on investments, data integrity for decision support, ability to aggregate valid data for public health use and practice evaluation, appear not to be well understood by key decision makers and many software vendors.

Healthcare environments

Healthcare environments can be described from any one of many different perspectives, such as financial, organizational, industrial, behavioral, philosophical, physical (healthcare building design) or population health trends. Health systems overall are influenced not only by service demand but also by external factors such as Government policies and legislation. Recipients of health services tend to view their healthcare environment from the perspective of access to services, service effectiveness and their experiences related to caring and welcoming aspects. Health service providers are likely to view their healthcare environment in terms of location, organizational facilities and culture, type and amount of service demand, resource availability, available support services, equipment, supplies and technologies, research opportunities, or environmental factors influencing health outcomes. From a workforce perspective, the adoption of environmental standards pertaining to the supply of workers, labeling, work protocols and procedures can contribute to improved patient safety.

The literature on healthcare environments primarily considers physical environments in terms of interior design, color schemes, acoustics, lighting, space usage, room and unit configuration, ventilation, environmental hygiene or links between internal and external environments [5]. The design of healthcare facilities is ideally influenced by a desire to design “healing environments.” Healthcare facility design must consider the needs and cultural preferences of the patient, family and staff. In addition designs need to meet various safety requirements to reduce opportunities for infection transmission, visitor, patient and staff injuries, enhance workflow patterns and processes, and minimize cleaning, building maintenance and heating/cooling costs.

In recognition of available evidence regarding the critical role of nurses in patient safety, the Institute of Medicine was asked to undertake a study some years ago to identify the key aspects of the work environment for nurses likely to have an impact on patient safety [6]. This study found evidence indicating that organizational management practices, workforce deployment practices, work design and organizational culture, that collectively make up the nurses' work environment, all contributed to many serious threats to patient safety. Nursing and midwifery working environments are covered in some depth in Chapters 6 and 11.

What influences the capacity to care?

This book's view of the health care environment is from a workforce capacity to care perspective. Such capacity is influenced not only by the knowledge, skills and numbers of staff that make up the available workforce, but also by all the nuances identified above, that collectively make up their working environment. Many of these factors are constantly changing based on service demands at any point in time. Changes occurring at other levels within the health industry may also have an impact at the point of care and/or influence service demand. Collectively these factors create a dynamic work environment for those directly or indirectly engaged in meeting health service demands. It is imperative that individuals making up the health service workforce have sound contextual knowledge of their dynamic working environment.

In situations where any of these supporting environments have deficits, health professionals tend to innovate and problem solve in an effort to minimize the impact on patient care. Their actions and behaviors directly address the actual survival of their patients/customers. This makes getting it right the first time imperative. Health service delivery is very much dependent upon collaborative teamwork. Individual team members depend on effective communication and information flows.

Fundamental to the delivery of health services is access to the right information and ease of access to this information in a timely manner. Information guides actions and assists in decision making. The absence of the right information is likely to cause delays in workflows, which in turn can result in extended periods of patient discomfort or adverse patient outcomes. The overall efficiency and effectiveness of health services actually delivered (productivity) is very much dependent upon service co-ordination, communication and information transfer strategies adopted.

Society and healthcare delivery systems have, and continue to experience major changes resulting from our ability to generate more data, and to transfer more information faster to more people at any one time than ever before. As a consequence, people's expectations are changing and the health industry, being information and knowledge intensive, is well suited to maximize the benefits of the new digital world. There is an urgent need for the health workforce as a whole to think differently about our communication methods, data and information flows, data collections and the way our key data assets are managed and made available for use.

Technically it is possible to almost simultaneously collect, aggregate and process lots of data about all possible confounding variables associated with any specific health issue and gain new insight regarding the best possible treatment or care options in a very short space of time. It's about our ability to collect practice based evidence. We need to be able to collect every bit of data once at the point of encounter, and use it many times to suit multiple purposes. Health system performance can be measured in a variety of ways. How should accountability boundaries be described? Murray and Frenk [7] argue that “it is unfair to hold health systems accountable for things that are not completely under their control; and health systems can achieve greatest impact through influencing non-health system determinants of health.” The latter is what contributes significantly to health service demand that in turn influences the capacity to care. They have developed a framework for health system performance measurement on the basis of:

1. 1. The levels to which health system goals have been attained irrespective of the reasons that explain t...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• About the authors
• Preface
• Acknowledgments
• Chapter 1: Dynamic health care environments
• Chapter 2: Health care operational inefficiencies: Costly events
• Chapter 3: Digital transformation needs to measure nursing and midwifery care demands and workloads
• Chapter 4: Nursing and midwifery work measurement methods and use
• Chapter 5: Identifying skill mix needs
• Chapter 6: Nursing and organizational models of care
• Chapter 7: Staffing resource allocation, budgets and management
• Chapter 8: Workforce planning
• Chapter 9: Digital health ecosystems: Use of informatics, connectivity and system interoperability
• Chapter 10: A digital transformation strategy enabling nursing data use
• Chapter 11: Measuring health service quality
• Chapter 12: Residential and community care management
• Chapter 13: Current and future vision
• Appendix 1: Case study 1 — Patient Assessment and Information System (PAIS): Work measurement research and workload measurement methodology
• Appendix 2: Case Study 2 — Design, development and use of the TrendCare system
• Index