What Would You Do to Fix the Failings of Healthcare Delivery ?

[RobbiRN, RN]

Suppose you have the authority to fix the failings of healthcare delivery in the US. Nothing is off limits, and you have the ability to implement change at any level. What would you do?

[TriciaJ, RN]

Nurse staffing.

[sevensonnets]

Yep, adequate staffing and everything else would fall into place.

[Castiela]

I disagree with the previous posters. Nursing shortages and inadequate staffing is only one of the symptom of the problems in healthcare in the us.

In an unlimited, perfect world, I would Direct the budget towards primary health care - smoking cessation, proper nutrition, education, dealing with the social determinants of health to prevent health problems. Implement a universal health care model such as France. Change the model from a business centred one to one focussed on health and wellness of the individual.

Unfortunately, I think the US would require a lobotomy before that would ever go through

[RobbiRN, RN]

Adequate staffing is crucial at the point of delivery and a great starting point for improvement at our level. What forces cause unsafe staffing ratios - and multiple other problems? Suppose you have the authority to fix the system at ANY level? (regulation, business, individual responsibility, litigation . . . nothing is off limits)

[RobbiRN, RN]

I disagree with the previous posters. Nursing shortages and inadequate staffing is only one of the symptom of the problems in healthcare in the us.

In an unlimited, perfect world, I would Direct the budget towards primary health care - smoking cessation, proper nutrition, education, dealing with the social determinants of health to prevent health problems. Implement a universal health care model such as France. Change the model from a business centred one to one focussed on health and wellness of the individual.

Unfortunately, I think the US would require a lobotomy before that would ever go through

The way I posed the question, there are no limits. I completely agree with your focus on replacing the business model that exists here. I like your attitude. It would take something like a lobotomy to fix the framework, but, for now, we are assuming a lobotomy is an option. Can you give us a short synopsis of how France's universal system functions?

[cyc0sys]

Remove the insurance companies from the health care industry.

Insurance companies are becoming extremely invasive to the medical process and should not be allowed to dictate how the provider will provide care to their patients. Extensive office visits and unnecessary tests are acceptable to scrutinize by withholding payment. Denying procedures which have a proven medical benefit or determining which drugs will be covered is dictating how the provider will practice medicine and should be illegal. It's unethical and undermines the patient's health in the long run. Medicare operates more efficiently and with less overhead.

Eliminate the ability of pharmaceutical industry to determine the price of medications by lifting the ban on government pharmaceutical price bargaining. By allowing the government to negotiate Part D prescription drug prices. This would reduce the overall cost of prescription medications to the American consumer, tax payer, and increase access for people who cannot afford them. American pay some of the highest costs for prescription medications in the world, in spite of the US Government subsidies R&D for new medications.

[RobbiRN, RN]

Remove the insurance companies from the health care industry.

Insurance companies are becoming extremely invasive to the medical process and should not be allowed to dictate how the provider will provide care to their patients. Extensive office visits and unnecessary tests are acceptable to scrutinize by withholding payment. Denying procedures which have a proven medical benefit or determining which drugs will be covered is dictating how the provider will practice medicine and should be illegal. It's unethical and undermines the patient's health in the long run. Medicare operates more efficiently and with less overhead.

Eliminate the ability of pharmaceutical industry to determine the price of medications by lifting the ban on government pharmaceutical price bargaining. By allowing the government to negotiate Part D prescription drug prices. This would reduce the overall cost of prescription medications to the American consumer, tax payer, and increase access for people who cannot afford them. American pay some of the highest costs for prescription medications in the world, in spite of the US Government subsidies R&D for new medications.

Insurance survives, and sometimes thrives, by taking as much money as possible in premiums and paying out as little as possible -- it's a business. For example, the CEO of Humana made $19,000,000 last year. He's just one of many officers and directors at the company. Removing insurance from the US healthcare equation would really upset some very wealthy people, but, again we are assuming everything is fair game.

(Try this link for a quick, somewhat nauseating look at where millions go: 'Sky-High' Pay For CEOs Of Health Care Firms Raises Questions : Shots - Health News : NPR

[DowntheRiver]

I agree with the others - staffing, insurance companies, and pharmaceutical companies need to be overhauled.

But what I'd really like to see changed is the nursing education process. I think we need to go back to basics on some of the ways that we educate our future nurses and focus on quality education. For example, when my mother was in nursing school (ASN/RN) in 1970 she did a year of theory, practicum, and clinicals. Her second year was hospital based, and she "worked" for that entire year on the same floor in the same department right beside the nurses under their mentorship. She did not have full privileges, of course, but upon graduation felt adequately prepared to assume a position as a RN after passing her NCLEX. According to her, it was a seamless transition. I say this because she observed me going through nursing school and how I had to literally compete with students for clinical opportunities. After retiring recently, my mom went back to do a nurse refresher course because she thought she could do home health, and she was appalled at the way the theory and clinicals were set up, and this was not the same school I attended! I also believe it would help some with the staffing issue. I'm sure not everyone would want to teach, and I know nurses don't always love having a student around, but I am one of those who does!

[Ben_Dover]

Staffing Ratios... I've heard in other parts of the states, some hospital still caters a 6-8:1 ratio.

Increase all of your salaries by at least 15K

1 month vacation

Must be dreaming

[Apple-Core, ASN, BSN, RN]

I would have a free universal healthcare system in place like there is in England (the NHS - National Healthcare Service), but with good compensation packages for all staff. Funding would come from wages/salary and would be a % of income. No insurance.

It would no longer be a business, it would be a HEALTHCARE system. Top admin wouldn't be paid ridiculous amounts, but salaries more in proportion to realistic standards.

I would make sure every hospital was adequately equipped with everything it needs in terms of supplies and technology.

I would staff appropriately to improve patient safety and reduce nurse and doctor burnout and stress.

I would funnel money into preventative care programs.

I would funnel money into social services and provide family support from the ground-up, because a lot of the issue begin there.

I would provide adequate resources in schools to educate in health and wellness.

I would funnel money into mental-health because that is tragically understaffed and underfinanced.

(....and I would also like to dive out from behind the wall saying, "hi, I'm John Quiñones......"and this is "what would you do??")

[bsyrn, ASN, RN]

Pay school nurses a reasonable wage!