Old school, getting back-to-basics: Population health defined

During a recent conversation with a healthcare industry leader, we discussed being "old school."

The philosophy of this lifestyle was defined for me early on when working three jobs to put myself through college, and appreciating the incredible quality of the first nursing unit I worked on as a registered nurse. Being 19 years old and new to the professional working world, I did not know what to expect. And it would not be until years later that I realized my first job set the bar for the highest caliber of professional nursing I would see.

The high standard was established during the interview process. The nurse manager (NM), Carol, stated point blank,

"If you want to work on this unit, you will not call in sick if I do not give you a requested day off. If you want to switch a shift or day, you will work it out with a coworker and come to me with the switch already established, etc. Now in return, I will do everything in my power to ensure that we deliver the highest quality of care for our patients. I will have your backs and make sure that you will not have to work short staffed, etc."

She instituted a mutually beneficial, professional relationship and self accountability with every new hire. All of the nurses also held each other to the highest standard. Each shift change, the outgoing nurse would be grilled, and if an assessment, lab or pertinent piece of information was unknown, well "you had best go find out right now and let me know." The NM mentored and fostered professional respect amongst the staff which created incredible teamwork. The outcome was the highest level of patient care because the unit functioned as a team centered on the mission - the patients - not as self-focused individuals. We were there for them.

After speaking with many clinicians, educators, nursing students, and other old school nurses who have gone through retraining for renewing their licenses, today's healthcare environment seems to have a growing divergence - between management and staff, staff and staff, providers and patients, and multiple vendors and delivery systems - as individual needs or agendas become the focus. One factor I see lending to the growing divergences is the basic lack of clear definitions with associated goals needed for an environment of teamwork.

Back-to-basics, understanding components with the five Ws

Population health is a top issue with healthcare reform and the reason for many initiatives. Several of my recent publications have addressed specific elements concerning the term, three were written specifically for leading up to this article as background supporting the need for a definition. The basic elements in the articles being the continuum the industry is spanning, the term population health, and the basic mission focus - the healthcare consumer.

Using the basic standard of information gathering of the five Ws, Population Health consists of:

Who: Providers, patients, advocates, educators. Providers are shifting focus to a value-based reimbursement model. In order to define and achieve value, patient accountability needs to be established within a partnership with physicians, acute care and long term care centers, home hospitals, and holistic care givers - avoiding divergence in achieving initiatives. Additionally, advocates are playing a key role for navigating the healthcare system, such as power of attorneys and community support groups (i.e. holistic care counselors, local community nurses, local health consortiums.) Partnerships in care need to be at a community level for monitoring compliance, ensuring patients are fully informed and in charge of their own information, as well as focusing initiatives based on the particular needs of a specific population.

What: Health instead of just care. Health should include the holistic care and preservation of physical, mental, and spiritual aspects for quality of life encompassing care delivery, health and medical education, patient advocacy, and healthy lifestyles.

Where: Expanded continuum. We need to expand the narrow focus of a care continuum to a health maintenance continuum to include prevention before needing care, and after care for sustaining health; care is only part of the continuum.

When: Daily and ongoing. Health is an ongoing endeavor throughout our lives, with standards of care and outcomes needing to be dynamic as health knowledge and treatments advance.

Why: Quality of life. Outcomes need to be tangible and quantifiable in order to measure success, and based upon individuals within the population to be patient focused. Outcomes cannot be generic based solely on demographics (e.g. age groupings) as lifestyles, comorbidities and individual wishes need to be factored.

Back-to-basics, population health defined – and let's not forget H

Population health is an established community of people, working in partnership with health providers, advocates and educators operating holistically as a team within an integrated health maintenance continuum, to perpetually achieve and enhance quantifiably agreed upon quality of life outcomes.

Once the five Ws are defined, the term population health is not complete without answering how.

How: Back-to-basics. Keep the mission focus and initiatives patient-centered for the individuals in the population. Maintain strong communication with the people and caregivers at the operational level. Foster professional teamwork with a partnership with those within the community with accountability of all parties.

By enhancing the quality of life of individuals, we obtain the health of the population.

 Rose Rohloff is a 30+ year healthcare veteran with a background of nursing, business and information systems with success creating industry leading business intelligence solutions for meaningful analysis. Her focus is the removal of information silos within health systems, and the expansion of the care continuum to a health maintenance continuum. Rose Rohloff can be contacted at rosemrohloff@outlook.com

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