Discussion 1: What is the difference between a protocol, standard of care delivery, and policy at the practice, state, and federal level? Briefly outline each. What are the perceptions of the health care delivery system from the perspectives of patients, providers, payers, and policy makers? Discuss at least one perception from one of the populations listed: patient, provider, payer, and policy maker.
A protocol is a set of guidelines or instructions that are followed and carried out, possibly without a physician’s order, to treat a patient or assist a practitioner in a procedure.
Standard of care describes the care patients should be offered by health care professionals and health services for a specific condition or defined clinical pathway in line with current best evidence. Standards of care are affected by policy and influence the protocols put into place. This all depends on the state laws as well as the private practice/hospital policies that could have an affect on them.
Policy refers to a law or regulation. Policy is what affects the protocols and standards of care. Policy at the federal level are decisions made in the legislative, executive, or judicial branches of government that are meant to influence actions at the state and local levels. A policy can then be modified at the state level to say change the scope of practice of NPs or what vaccinations are required of students. At the local level, private practices, or hospitals, have their own policies to include how they respond to disasters and how to manage their nursing staff. All three levels of policy can have effects on protocols and standards of care.
Looking at the latest Gallup polls, the current satisfaction rate with the quality healthcare in the country is low with “excellent” at 12% and “good” at 38% for Nov 1-16, 2021. The rating of quality of medical care in the nation for 2022 shows “very satisfied” at 17% and “somewhat satisfied” at 29%. When rating the total cost of healthcare, the satisfaction rate is at 22% and the dissatisfaction is at 77%. Overall, I would say that the patients taking the survey have an overall bad perception of the health care delivery system.
Discussion 2: Protocol:Protocols are a set of rules that, in this case, guide and govern nursing practice. They are established through research and/or evidence based practice. These rules satisfy the principles of ethics and nursing codes, recommended by the ANA, or American Nurses Association. So essentially, protocols are a set of procedural standards that dictate in which manner care should be provided, with specific parameters, limits, instructions along the way.
Standard of care delivery:The most simple way to understand this principle is that standard of care is the universal way that care is provided, with each provider providing the same specific care, using the same moral, ethical, and research based principles. It’s how every provider would do a particular thing, in the same way, using the same technique, etc. For example, in nursing, this could mean that each nurse administers a particular medication in the same way, adhering to the same rules and factors surrounding the administration of that particular medication. It could also mean responding to an acute situation in the same way, using the same process. Basically think, “I would do what any other nurse or provider would do in this situation.”
Policy:Policy in a general definition, is any laws, regulations, or administrative actions that govern practice and address specific issues, holding people, and in our case providers,accountable for their particular actions. At the practice level, policies allow for safe and conducive workplace environments that promote the wellbeing and safety of patients as well as providers. Policies at the practice level apply to hospitals, outpatient practices, community health centers, and so on. They help to promote the mission statements and goals of particular organizations, in the most safe, efficient way possible. State policies help to govern healthcare in a more general way. Considerations such as patient ratios, safe practices, employee breaks/ lunch breaks, etc, disease reporting, etc. All designed for organizations to provide more safe care, and patients to have better outcomes. At the federal level, policies govern healthcare on a more grand, overarching scale. Here we look at things such as medicare/medicaid programs, universal healthcare, funding to increase healthcare professionals, funding for healthcare research, etc.
Perceptions of the healthcare delivery system:patients, providers, payers, and policymakers all have their own perception of healthcare based on their particular relevance to the system and their needs as it pertains to healthcare. Of course patients want the highest quality of care, at the lowest cost. They want their care to be patient centered, and result in the most optimal outcomes. From my own experience, most patients now feel like the system has become generic. I have patients constantly telling me doctors don’t spend nearly as much time as they want or need and don’t always keep them informed about their care process. Providers themselves want to provide the best care possible, with the most optimal outcomes, but they are increasingly confined and limited by the bureaucratic process of healthcare, with increasing documentation requirements and practice limitations. Payers want to fulfill a healthcare system that delivers affordable healthcare to all recipients and protect financial interests of providers and organizations alike. Policymakers want to ensure that people have access to quality, efficient, healthcare that will promote their well being. Increasingly we have seen policymakers involved in providing relief to the healthcare system itself through implementation of policies that recognize healthcare workforce shortages and burnout.
When we consider providers in more depth, we understand that healthcare today is governed by different standards, rules, and regulations than it was years past. In reflection of state specific and wider federal regulations, documentation has become more of a burden than actual physical care itself. Doctors find the increasing demands of proper documentation and tighter regulations on practice reason to retire early. The system itself has put more emphasis on covering one’s practice from litigation and liability, and this in return has taken away from the quality and time that is given to physical care itself. I myself have experienced both extremes on this spectrum. I have practiced at facilities where the emphasis was placed on physical care, and at the opposite end, facilities where more than half a shift is spent on documentation. Of course it seems that now and days patients need any reason to file legal action and so it creates a detrimental cycle that ultimately takes away from healthcare delivery as a whole.