6 Key Principles That Will Guide the Bedside Care Team of the Future

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Healthcare industry experts came together to determine how the bedside care team needs to transform to adapt to the changing U.S. healthcare system.

The U.S. healthcare system is in the midst of numerous, significant changes. In 2014, millions of people will gain health insurance coverage under the Patient Protection and Affordable Care Act. The U.S. population is aging and therefore requires an increasing amount of treatment. The healthcare system is shifting from fee-for-service payments to value-based reimbursement. In light of the healthcare system's transformation, the traditional bedside care team may no longer be the best or even a plausible approach to care, according to the American Hospital Association.

The AHA recently convened a roundtable of experts to discuss how the bedside care team should be reconfigured to meet the shifting needs of the U.S. population. The composition and focus of the group of clinicians who administer bedside treatment will need to change significantly in line with the transforming healthcare system.

The participants came up with six principles that should guide bedside care team reinvention, summarized in the whitepaper "Reconfiguring the Bedside Care Team of the Future." The principles reflect an anticipated shift toward shorter acute-care stays focused on specific clinical outcomes and less of a physician-centric model, among other expected changes.

Discussion participant Michael Bleich, PhD, RN, FAAN, dean of the Goldfarb School of Nursing at Barnes-Jewish College in St. Louis says care providers will need to change gears from looking at care through the lens of treating existing illness to approaching it with a prevention-and disease-abatement focused mindset. Getting to know patients and making them part of the care team will also be crucial.

"We need to be more outcomes-focused, based on a sense of personally knowing what the patient and the family experience is," he says. "Patients are presenting with whole new syndromes manifested through multiple overlapping diagnoses and complexities. At some point, someone needs to have a perspective on who this person is and what the patient wants as a  care outcomes in addition to what clinicians want."

Here are the six guiding principles Dr. Bleich and the other roundtable members identified for bedside care team evolution during the next five years.

1. The patient and family are essential members of the core care team. Patients likely won't return to optimum health unless they and their families become an integral part of healthcare decisions, according to the AHA whitepaper. Must-haves for providers implementing this principle include clearly presented and respected advance directives and care co-created and shared with an engaged patient and/or family to share responsibility for care plan compliance, among other key elements.

"Even though many hospitals will say they're patient-centered, I think that, more likely, providers are  patient-sensitive, but the processes of care that clinicians use may not be patient-centered" Dr. Bleich says.

2. Bedside care team members need full organizational support. The bedside care team's success depends on engagement at the broadest scope of their practice, according to the AHA. Examples of engagement include hospital leaders at the highest level supporting an environment conducive to team success, physicians actively engaging on committees and team members showing respect for all provider roles.

3. The care team must be highly effective, focused and autonomous. The future care team will need to be highly focused, limiting their work to the patients and families on one specialty exclusively, according to the whitepaper. Otherwise, the team will become fragmented and less effective. Characteristics of this focused care team structure include clinician members with a variety of capabilities that are in the best interest of the populations they serve.

Dr. Bleich says it will become increasingly crucial for hospitals and health systems to identify and define the populations they treat, which could be characterized by a number of factors such as gender, age or geographic region.

"How are we going to define population management in reconfiguring care processes and location? " he says. "Or Is it only just an economic lens? That's a strategy that conversations need to be had about right now, with multiple lenses, not just an administrative or a physician perspective."

4. All team members will play equally important roles in patient care. The reconfigured bedside care model should move away from its current arrangement where the physician is the "captain of the ship," according to the whitepaper. Under the new team model, nurses and all other clinicians will use the full extent of their professional knowledge, training and skills to deliver the highest quality care possible.

In order to make this transition, Dr. Bleich says care providers will need to consider the scope of practice various clinicians such as nurses, physical therapists and pharmacists will have.

"If we're going to respect each other as part of a team, we have to have conversations around what the optimal scope of practice  for each discipline, how we respect that and how much freedom we have to work together," he says.

5. Technology should replace some clinical tasks, as well as enhance the decision-making and clinical judgment of the team. Technology can support the bedside care team's treatment of the patient. However, before implementing new technology, the roundtable concluded the provider organization should evaluate its efficiency and contribution to patient outcomes, considering factors such as how much time it will require at the bedside and whether or not it will increase productivity.

Additionally, patient education tools should be integrated into new technologies, taking into consideration patients' varying backgrounds and needs. Technology should be sensitive and flexible to language, culture and ethnicity.

6. Patients that need acute care should move safely through the system whether they are at the onset of disease, in the midst of community-based care or undergoing end-of-life care.  According to the whitepaper, this principle will result from the enactment of the first five principles. The care team should strive to deliver high-quality services in a safe way. For instance, team members should always provide information to the patient in a clear and transparent way. Additionally, they should incorporate checklists into the care process and the technology infrastructure.

Overall, Dr. Bleich says this reconfigured care team model will need to take effect sooner rather than later, given the rapid pace at which the PPACA, the rise of population health and other forces are transforming the industry.

"This notion of acute care being part of the continuum and not the central focus of all care is probably shifting more than any of us recognized when we sat down to write this," he says of the paper.

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