Hirons,
Hi professor and classmates! Value based healthcare is the focused on the quality of care and patient satisfaction. Volume based healthcare focuses more on profit. Patients are charged one large fee for any service they might need from a single provider. The goal in value based healthcare to improve patients experiences and outcomes and reduce the extraordinary costs of healthcare services (Caron, 2019).
I am a nurse leader in a psychiatric hospital. We talk about patient safety constantly, but the context for a psychiatric population is much different than other patient populations. The most common reason for admission to the psychiatric hospital is suicidal ideation. Usually when safety is discussed, we are considering the patients ability and likelihood of harming themselves or others. I teach a training about de-escalation, self-defense, and restraints. All staff are required to attend the training annually to stay updated on the most recent evidence-based safety measures. In this class, I emphasize the importance of maintaining safety. My organization does promote a culture of safety for both patients and staff. This is evident in frequent education, policies, safety protocols, and comprehensive discharge planning (Sanchez et al., 2021).
To improve safety outcomes, I would like to implement a discharge program in which we call to check in on patients upon discharge. Patients admitted to a psychiatric hospital are at extremely high risk for suicide completion upon discharge. This is why safety planning is so crucial to patient safety. Our social work team makes sure each patient has a support system, outpatient appointments, medications, and an action plan in case suicidal thoughts return. However, I think adding in an extra precaution, checking on our recently discharged patients, would benefit our patients and reduce the risk of suicide completion(Sanchez et al., 2021).
My strategy for implementing this plan is create an inter disciplinary committee of nursing staff, providers, and social workers. My proposal would be to assign one social worker to be our discharge coordinator, who is responsible for making these follow up calls. He or she would touching base with our recently discharged patients. This social worker would document the conversation in the patients chart. If the patient need assistance with resources, the social worker could help them. If the patient is voicing hopelessness or suicidal ideation, the social worker could encourage the patient to come back to the hospital. If the patient is voicing suicidal ideation and refusing to go to the hospital, the social worker would need to contact the police for a welfare check. We are a hospital with 60 beds and I do not think this would require another full time social worker. In considering a budget proposal, I would initiallysuggest that this added role would be 50% of a full time social workers responsibilities or a part time social workers full responsibilities (Conti et al., 2020).
Current technology used to support patient safety includes the use of video monitoring throughout the hospital, except for in the bathrooms. The goal is to allow patients to have privacy, so staff members arent following them, but can still monitor the patients at all times. Unintended consequences include patients experiencing paranoia. To address this consequence, I am honest and genuine with patients. I say these cameras are only here to keep you safe. We want to make sure that other patients dont go to the wrong room and that we can come help you if you need it. I also assure the patients that there are no cameras in the bathroom, so to change clothes in there. If the patient is based in reality, the patient is usually satisfied. However, if a patient is very paranoid or experiencing psychosis, this is a little more difficult. If this is the case, I resort to active listening skills and validating the patients feelings. I also emphasize that the patient is safe (DeMasi, 2018).
Working in mental health, I experience daily frustration over insurance companies power over the treatment we can provide to mentally ill patients. I had a patient who was admitted to the psychiatric hospital for a few weeks. The utilization review department (who communicate with insurance companies) said the patient had exhausted his days and would need to be discharged. The patient was not safe to leave. He had a very specific plan to die by suicide, no support system, and no place to go. Thankfully, the provider and other members of the treatment team were not willing to risk the patients safety based on an insurance companys willingness to pay. However, this was an eye opening experience. It seemed like volume based care focused on the amount of days the patient was in the hospital, rather than the patients actual safety (Caron, 2019).
References
Caron, R. M. (2019). Co-producing healthcare in a volume vs. value-based healthcare system: perspective of a parent of a patient and a health professions educator. Patient Experience Journal, 6(2), 1619.
Conti, E. C., Jahn, D. R., Simons, K. V., Edinboro, L. P. C., Jacobs, M. L., Vinson, L., Stahl, S. T., & Van Orden, K. A. (2020). Safety planning to manage suicide risk with older adults: Case examples and recommendatioms. Clinical Gerontologist, 43(1), 104109.
De Masi, F. (2018). Working with difficult patients: from neurosis to psychosis . Routledge, an imprint of Taylor and Francis.
Snchez-Teruel, D., Robles-Bello, M. A., Muela-Martnez, J. A., & Garca-Len, A. (2021). Resilience assessment scale for the prediction of suicide reattempt in clinical population. Frontiers in Psychology, 12, 673088673088. https://doi.org/10.3389/fpsyg.2021.673088
