NR 506 Week 5: Drivers of High Performance Healthcare Systems SOLUTION

NR 506 Week 5: Drivers of High Performance Healthcare Systems SOLUTION

Drivers of High Performance Healthcare Systems No unread replies. No replies. Select two drivers (for example quality, cost, and access) of high performance healthcare systems and apply it to your current work situation. The application could demonstrate t

Drivers of High-Performance Healthcare Systems

A high-performance healthcare system is defined in the dimensions of quality, cost, access, equity, patient experience, and patient safety. In a high-performance healthcare system, the overarching goal of ensuring that every individual lives as long, healthy, and productive lives as possible is met (Ahluwalia et al., 2017). Besides, patients get the proper care documented to be effective for treatment, prevention, or palliation, and overuse, underuse, and misuse are absent. In these healthcare systems, patients receive coordinated care over time, with an advanced primary care practice responsible and accountable for every patient’s care. Furthermore, the care provided in high-performance healthcare systems is safe and from organizations particularly trained to minimize errors (Ahluwalia et al., 2017).  Healthcare is patient-centered and provided promptly with service excellence. In addition, the systems provide patient care that is the highest value for the finances spent and is delivered efficiently. The care is also affordable from the patient’s and payer’s perspective.

Quality is a crucial driver of a high-performance healthcare system because it significantly determines patient outcomes. Quality in healthcare is a broad term that includes many aspects of patient care. Quality health care is safe, patient-centered, effective, timely, efficient, and equitable (Busse, Panteli & Quentin, 2019).  Healthcare systems need to improve the quality and the value of the care provided in order to enhance patient outcomes. Ensuring high quality of patient care has greatly influenced high performance in my healthcare organization.

NR 506 Week 5 Drivers of High Performance Healthcare Systems SOLUTION
NR 506 Week 5 Drivers of High Performance Healthcare Systems SOLUTION

I currently work in a medical-surgical unit, where we take care of adult patients diagnosed with various medical and surgical conditions. High quality of patient care is promoted by using evidence-based practice (EBP) to guide patient care interventions. The use of EBP ensures that medical and nursing interventions are of high quality and based on best practice to promote the best possible patient outcomes. Quality is also promoted through effective chronic care management since a majority of elderly patients in the unit have chronic illnesses. The organization has formulated chronic disease guidelines that guide health providers in delivering quality chronic care. High-quality chronic care has been attributed to reduced hospital stays, readmission rates, morbidity, and mortality rates among patients with chronic illnesses.

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The organization’s health care quality initiatives seek to improve patient safety through action plans that focus on preventing adverse drug events and healthcare-associated infections. For instance, the organization has instituted

NR 506 Week 5 Drivers of High Performance Healthcare Systems SOLUTION
NR 506 Week 5 Drivers of High Performance Healthcare Systems SOLUTION

technologies, such as computerized physician order entry, barcode medication administration, and automated dispensing, to reduce medication errors. The organization has also strived to maintain safe nurse staffing ratios to promote quality nursing care, improve patient safety, and prevent cases of missed care caused by short staffing. Besides, nurses and other health professionals are provided free training on promoting quality care and preventing hospital-acquired infections such as catheter-associated urinary tract infections. Furthermore, high-quality care is promoted through care coordination across sites of care, particularly when patients are transitioning from the hospital to other settings. Care coordination ensures that patients are provided with appropriate and high-quality care to reduce readmission and morbidity rates.

The cost of healthcare in our organization is generally high, and it has been rising tremendously over the years. The high cost of patient care is a major concern and is associated with disease prevalence and incidence, health services price and intensity, the rising cost of pharmaceutical drugs, advanced healthcare technology, increased health service utilization, and population aging. Approximately 50% of the increase in healthcare spending in our organizations comes from increased healthcare costs, especially inpatient hospital care for elderly patients.

The increased prevalence of chronic illnesses is responsible for the greatest increase in spending and drastic rise in patient care costs. Health conditions associated with the greatest increase in costs in the medical-surgical unit include diabetes, hypertension, low-back and neck pain, high cholesterol, urinary infections, osteoarthritis, bloodstream infection, and falls. Furthermore, ambulatory care, including outpatient hospital services and emergency room care, contributes to increased healthcare costs in the organization.

The organization and health providers can address the concern by putting a greater emphasis on primary care. This can help lower the costs of care, improve healthcare by increasing access to more appropriate services, and reduce the inequities in the population’s health (Busse et al., 2019). The organization can also tackle the issue of cost by enhancing disease management and primary care case management and expanding the use of information technology (Busse et al., 2019). Besides, it can recommend using evidence-based guidelines to determine whether a test or procedure is necessary and have all payers, including Medicare, Medicaid, and private insurers, adopt common payment methods and rates.

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Ahluwalia, S. C., Damberg, C. L., Silverman, M., Motala, A., & Shekelle, P. G. (2017). What defines a high-performing health care delivery system: a systematic review. The Joint Commission Journal on Quality and Patient Safety43(9), 450-459.

Busse, R., Panteli, D., & Quentin, W. (2019). An introduction to healthcare quality: defining and explaining its role in health systems. Improving healthcare quality in Europe, 1.


I chose to explore the cost of and access to healthcare in a high performance system.  As an ER nurse in one of the largest healthcare systems in Illinois I have witnessed the increase in ER visits and overcrowding since I transferred to the ER 12 years ago.  My workflow has changed drastically from what it had been.  In the ER patients cannot be refused treatment related to necessity or their ability to pay due to The Emergency Medical Treatment and Labor Act (EMTALA) that was passed in 1986 (Williams & Hertelendy, 2014).  This has caused those without insurance or ability to pay to be seen in the ER for non-emergency related complaints because they are refused elsewhere.  Accessibility of seeing a doctor for the uninsured and underinsured was made easy by this law because patients are not turned down.  At my hospital our registration department offers patients a financial packet that allows them to meet with a counsellor after their visit to discuss a possible sliding scale payment or in some circumstances the bill is written off.  While the ER opens up access to care, it is not a place for patients to go when they have chronic diseases that require frequent follow up and monitoring.  Nor is it cost effective.  Patients who utilize the ER as a primary care causes overcrowding and can “prevent EDs from assessing and treating critical patients in a timely manner which could ultimately lead to death or disability” (Williams & Hertelendy, 2014, p. 614).

The article by Williams & Hertelendy also discusses how the Affordable Care Act would give health insurance to more people which would cause more patients to utilize EMS and ED services and further increase the strain on the systems.  They proposed a few interesting options to overcome and prevent the strain and one idea which has been used in Great Britan is the use of paramedic practitioners who have advanced assessment skills and training that would allow some people to be treated and not transferred.  They also mentioned utilizing telemedicine so the paramedics could consult with a doctor.  “Positives of this option include decreasing the amount of EMS transports by approximately 15%” (Williams & Hertelendy, 2014, p. 617).

This article was published 4 years ago and over the past 2 years my hospital has started to implement similar methods to continue operating and allow access despite the shortage of nurses (and especially ED nurses).  We began hiring paramedics to work in an advanced-tech role which gives them additional responsibilities such as the insertion of IV’s, catheters, and charting.  We work in a pod which consists of 10 rooms all equipped to handle any acuity patient.  Previously we staffed each pod with a doctor, health unit clerk, 3 nurses, and a tech.  Now some of the pods operate with a doctor, health unit clerk, 2 nurses, and 2 paramedic-techs.  I have mixed feelings about the model.  On paper our numbers (related to discharge times and overall patient turnover) in those pods look better than the traditionally run pods, but there’s much more to patient care than those numbers.  It’s challenging when you have a critical patient because I feel my other patients aren’t being seen by their nurse, even if they are rounded on by the medic.  I prefer more time with my patients and I feel that I assess many things about them while inserting their IV and getting vital signs.  Often times that’s when I pick up on something crucial to their care.  Management sees the medic-tech as a way to increase access and drive down hospital costs.  I see pro’s and con’s on both sides but I do feel that the future will continue to involve more medic-techs and medical assistants in positions once held by nurses.


Williams, G. R., & Hertelendy, A. J. (2014). The expanding scope of EMS: decreasing emergency department overcrowding in the United States. Journal of Paramedic Practice6(12), 614-619. Retrieved from