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Editorial
Setting the Agenda for Consumer-Oriented Care in the New Millennium
Margaret McMillan
Professor and Deputy Executive Dean, Faculty of Health, University of Newcastle, Newcastle NSW
Article Text
At present, consumers are more informed about health care services, given the ease of access to information using the electronic media. Therefore, consumers expect the most current treatment regardless of expense or geographic location of the service. The health care sector is feeling the impact of rising consumer demand for services. This is a result of, among other factors, an ageing population, and it is struggling to provide services in an environment that was not designed to meet the current demands and the many changes that have occurred within the industry (NSW Health Reform Agenda, 2000).
There has been unrelenting change within the health care system over the past decade as a result of the increased use of biomedical technology, advances in science that are reflected in the medical management of patients, continuing development of information technology, and ongoing economic rationalism. There is a lack of co-ordinated, streamlined approaches and limited consensus on approaches to managing the health care environment and patient care practices. There have been blocks to achieving efficiency and a level of efficacy identified by, for example, NSW Health, that has resulted from fragmentation of services, which is reflected in a non-streamlined approach to patient care. The resulting lack of a continuum of care for patients, from point of entry into the health care system to discharge, does not facilitate the provision of optimum patient care or appropriate use of the services. Current information systems are inadequate, there is duplication of costs as a result of the unco-ordinated approach to patient care provided by health service personnel, and the demand for hospital beds is at a premium when often they are being used inappropriately.
The implementation of changes that are advocated within the health care systems worldwide has generally not been co-ordinated, formally acknowledged or managed, but rather has often been allowed to unfold with little or no support for the health care workers. And yet, Health Departments expect that the changes in the sector be driven and managed by clinicians. To enable the health care workforce to meet the demand for its services, changes to the roles and functions of health care personnel need to be examined and a more co-ordinated approach to patient care developed for effective and efficient utilisation of the health care system. Because nurses are the largest group of clinicians within the system and provide a service across the 24 hours in a day, it is reasonable to expect that those nurses will be instrumental in facilitating changes within the health care environment.
Given that change has occurred haphazardly over a period of time, the changes have been ill defined, largely poorly managed and not evaluated for their effect on either the service or on patient outcomes. Hence, it will not be surprising if workers express cynicism regarding demands for more changes.
The health care industry needs a change model that will facilitate a learning environment to enable clinicians to manage change while simultaneously developing health care workers who are knowledgeable about contemporary health care practices. Clinicians need to engage in deliberations about new models of care. This will necessitate a willingness to scrutinise closely their existing practices and not continue to attempt to apply outmoded processes and practices. There needs to be a closer alignment between the consumer’s actual needs and the roles, functions and activities of nurses. This will require challenging old-world views if we are to capitalise on this opportunity for reconceptualising and organising our practices.
If nurses are to be instrumental in bringing about the changes that are necessary to align health care services with patient care, there is a also a need to address the current significant attrition rate from nursing. The development of new models of care might be invaluable in assisting with this challenge as health care organisational forces determine the conditions under which nurses work. Studies have identified organisational culture and a lack of autonomy in decision making and change as contributing stressors for nurses. Advances in technology have also been cited as impacting on the nurse’s role.
Consideration therefore needs to be given to whether or not the roles and functions of nurses in a range of contexts of practice have changed or need to change. Perhaps greater emphasis needs to be placed on different functions in particular situations, because of changing patient care needs and the reduced timeframe in which care is expected to be provided. The feasibility and practicality of delivering total patient care has to be questioned in a range of contexts of practice. Across the world, references are being made to a modernisation agenda. One of the core elements of that agenda centres on putting the needs of patients ahead of those of the institution. Nurses have to be very clear about whether or not their practice is consumer oriented. Any desired change in the culture within the sector and the experiences of nurses will not occur overnight. However, this is an opportunity for nurses to demonstrate their skills in making a difference to outcomes for their clients. In a way, it is a chance to invest in our profession.
It is imperative that nurses are involved in the development of new models of care and the broad change processes. By maximising the contribution that nurses make, we can reduce the potential for further stress in the workplace. However, this will require a new level of insight and forward planning for the development of approaches to practices that meet the needs of patients within a complex and changing health care environment and society at large, rather than waiting for change to be imposed upon us.
To achieve sustainable change in today’s complex health care environment, it is essential to have nurses with well-developed leadership qualities, a sound grounding in nursing practices, and clear identification and understanding of the contemporary environment. To determine the appropriateness of various configurations of roles and functions within a range of models of care, nurses themselves need to assume responsibility for proposing strategies for change that are realistic and effective at the coalface.
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