NR 506 Week 5: Drivers of High Performance Healthcare Systems

NR 506 Week 5: Drivers of High Performance Healthcare Systems

NR 506 Week 5 Drivers of High Performance Healthcare Systems

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 the presence of the driver in a positive manner or it could acknowledge the presence of a concern.

In my opinion two drivers such as quality and cost are the most importance in high performance healthcare systems. However, it is hard for the two drivers to go hand in hand. One would think that in order to get high quality healthcare, it would cost more. In my current work situation there is always a staffing shortage in the ICU, probably because other departments RN cannot float to ICU since it is a specialty unit. It costs hospital to staff RNs in order to provide quality care and maintain the patients to nurse ratios. Not having adequate staff due to cost containment can jeopardize efficient quality healthcare. “Nurse staffing has a significant impact on both quality of care and cost due to nurses’ vital role as front‐line care providers, and insufficient staffing and unreasonable home healthcare costs can thus reduce health benefits through missed opportunities to improve patients’ health status” (Park, 2017).

People tend to associate things that are not costly with poor quality. Which comes to mind, the objective of the “Patient Protection and Affordable Care Act (ACA)” was to attain virtually worldwide health insurance coverage in the United States. ACA helped a lot of people get insurance for an affordable price. “On the supply side, concerns have been raised about whether there are sufficient numbers of primary care physicians to treat all of these newly insured patients” (Courtemanche et al., 2018). Now that everyone could be insured, the question is how will the quality of care be affected? What types of physicians will care for these patients. Time with patients will be compromised due to lack of time to see patients. I believe there must be a medium for quality of healthcare and cost.


Courtemanche C., Marton J., Ukert B., Yelowitz A., & Zapata D. (2018). Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self-Assessed Health. Southern Economic Journal. 84(3), p660-691. 32p. DOI: 10.1002/soej.12245.

Park, C. S. (2017). Optimizing staffing, quality, and cost in home healthcare nursing: theory synthesis. Journal of Advanced Nursing. 73(8): 1838-1847. 10p.

I completely agree with your discussion concerning the importance of quality and cost in a healthcare system.  I also chose those two factors for the topic of my discussion.  One of the United States developmental goals is to ensure healthy lives and promote well-being through quality healthcare (Kruk, Kelly, & Syed, 2017). Studies show that examining variations in quality healthcare allows healthcare professionals methods to diagnose drivers of performance (Kruk, Kelly, & Syed, 2017). Thursday, I spent all day in the emergency room with my grandfather that was experiencing blood pressures as high as 240/120.  According to, the average cost of an emergency room visit is over two thousand dollars and the average wait time is over two hours for admission (, 2017).  With that statistic at thought, a person would expect good quality.  However, that was not the case.  As a nurse and family member, I was very disappointed in the quality of care and as a consumer, I would not visit that facility again.  I was able to diagnose drivers of performance that impacted my healthcare experience.

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Kruk, M., Kelly, E., Syed, B. (2017).  Measuring quality of health-care services: What

is known and where are the gaps?  Bulletin of the World Health Organization (95),

6, 389-390.

I would agree with you in the situation you presented about staffing ratios and that quality of care is thought to cost more.  The truth it is always great to have the best ratio possible when it comes to staffing with nurses to patients.  We have experienced how it is to be short on the floor and have the best staffing possible.  I think though that it does not diminish the quality of care we try to give to our patients as nurses.  Even when it has been short on the inpatient unit I use to work on we still received positive feedback from patients, and a lot of times understanding as well.  Patients can tell when someone really cares or not an is providing quality care to them.  I think that the cost of how important staffing is forgotten until something happens like a major fall or a sentinel event.  Really that ends up costing the hospital more than just monetary losses, but other ones.  Most of us in nursing are here to help people and be compassionate and supportive for our patients.

In terms of patients’ insurance coverage or economic status, I made sure to treat every person as equally as I could in regards to the care I provided for them.  I cannot dictate the tests or other provision for the patient, but I can do the best I can and treat patients equally across the board.  I do agree that each person should have equal access to healthcare in our country no matter what, and at the highest quality possible.  Hopefully as we continue on our healthcare journey those who make these decisions will see that it takes spending money to save money, and when nurses are compensated better and treated better there will be a decrease in turnover.

There are many potential drivers in the healthcare system but two that are very important are cost and accessibility. The cost of healthcare can be a controversial issue for many individuals, which is why it is so important. The changing cost in healthcare can be for many reasons including pharmaceutical changes, technology innovations, healthcare reforms and even government expenditures (McGrail & Ahuja, 2017). This affects both the patient and the hospital on a daily basis. Our hospital has just opened its own pharmacy for the use of not only employees, but also the patients and the community. The goal for the pharmacy was to cut down the cost of prescribed medications for the patient and their families. The pharmacy has been open for about a year now and the feedback has been great. Patients are getting their prescriptions at half the cost of anywhere else, if not more. It does make me wonder however, why other places are charging such large amounts. I do feel that the pharmacy in the hospital is a positive driver in our hospital’s situation.

The second driver is access to healthcare. In our town, which is quite small and only has the rural hospital, there are two healthcare facilities or physicians’ offices. Both offices are open regular hours, 8am-5pm and provide no urgent or afterhours care. Due to this, in the evening and on weekends, the emergency room is very busy but not with trauma, with things likes ear infections, influenza and headaches. In our area, access to care outside of normal business hours is non-existent. This is a huge negative for the community, patients and even staff members. This can also tie back into the cost as well. Instead of the patient paying for a simple Doctor’s visit, the patient must pay an emergency room bill, which can sometimes be triple the amount. This may be a positive driver in terms of money for the hospital but definitely negative for the patient and patient care all together.


McGrail, K. Ahuja, M. (2017). What is bending the cost curve? An exploration of possible drivers and unintended consequences. Healthcare Policy, 13(2), 20-30.