With the NHS challenged to make a further £30bn worth of cost savings by 2020, the pledge by nurses to be centred on individuals experiencing high value care reflects a continued focus by nurses on patient care and the kind of grit it will take to navigate health services through post-Brexit UK. High value care has come to mean improving outcomes for patients while decreasing costs, and among the considerations that nurses face, are adequate staffing, how to maintain their ongoing training and how to ensure that their invaluable input is both recognised and acted upon at a policy level.
High value care organisations
Writing for Forbes magazine online, Sachin H. Jain, CEO of the US-based CareMore Health System, describes six principles for how value-based care looks in practise. “For the average patient,” writes Jain, “true value is accrued over years of preventing chronic diseases and delaying their progression.” Health institutions that are focussed on value, he says, take “a longer-term view of patient outcomes” in an effort to circumvent more costly health events in the future. Early investments take into account the unit cost of delivering healthcare and focus on resource allocation - ensuring that patients receive care from the most appropriate professionals to deliver the services they need. According to Jain, value-based healthcare also requires a patient-focussed “culture of caring” and a “whatever it takes approach.”
In the UK, despite the challenges, nurses are poised to be the best advocates of high value care and according to one report by King’s College, “the nurse is the most important factor in securing [a high value care] experience for patients. “The nursing framework ‘Leading Change, Adding Value’ is already built upon the the 6Cs - care, compassion, courage, commitment, competence and communication - and shows that nurses are aware of their leadership capacity when it comes to the development of a value-based National Health Service.
Safe staffing levels central to high value care
However, according to the International College of Nursing’s (ICN) 2015 publication, ‘Nurses: A Force for Change, Care Effective, Cost Effective’, “at times of economic austerity nurses are often the first to be reduced which is detrimental to patient safety and quality of care.” News of nursing shortages has become common with, according to Nursing Times, both children’s palliative care and social care provided to older people affected by “the declining number of district and community nurses.” Delivering high value care means that nurses have to ensure adequate staffing levels to better guarantee “patient safety, quality of care and patient satisfaction.” This says the ICN will require “participation in policy making and resource allocations in order to lead from the frontline.”
The UK’s Royal College of Nursing (RCN) is very aware of this and has been lobbying for policy mandated staffing levels. On its dedicated website for this, 4to1.org.uk, the RCN suggests that the NHS “look overseas for examples of what can be done differently” when it comes to nursing staff shortages and expresses the belief that “only a social movement of NHS workers and patients pressuring the government will be able to deliver these important protective measures for [the] NHS.”
The RCN’s April 2016 publication, ‘The nursing role in integrated care models, Reflecting on the United States’ experience’ underscores their position that there are lessons to be learned, especially from the way that healthcare is managed in the United States. While acknowledging that the “US and UK health care systems have different funding and incentive structures, cultures and infrastructures in place”, the publication highlights that “safe, high quality and patient-centred care that delivers value for money” is possible by acknowledging and making use of the crucial role that nurses play. The key features that emerge from the exploration of 3 successful American healthcare models, says the RCN, are “leadership, strengthening communication, shared governance and co-ordination roles.” Of critical importance for the RCN in the exploration of US models, is the successful lobbying efforts by nurses in California who were able to secure a 5:1 nurse staffing ratio mandated by government policy in 1999. “There nursing unions campaign in the workplace and on the streets,” writes the RCN, “hold rallies to mobilise the public and take strike action against the government. They have better pay and conditions, and mandatory staffing levels. In the UK, nursing unions fail to act, our working conditions deteriorate, our patients suffer and our profession is in crisis.” In short, nurses in places like the US and Australia, do whatever it takes.
Education empowers high value care
The nurse as an educator is especially important when it comes to the development and management of high value care. The ability to provide true value, as espoused by Jain, and to prevent the escalation of patient conditions is directly connected to effective health promotion interventions by nurses that address “low health literacy” and empower patients towards self-care and the confidence to manage long-term chronic conditions. The development of the relationship between the public and health services does not end there and especially when it comes to safe staffing levels and mobilising public support, nurses will need to educate the public on the importance of the role they play. This includes says the ICN, “drawing on their professional legacy as patient advocates” who help to reduce violence against women and children and who in their close interaction with health service users in various settings have a good understanding of health needs and how different factors in the environment impact the health of patients and their families. For instance, says the ICN nurses could work “outside of the health sector to share their insights on the design of homes and community environments that help maintain independence and avoid risks that result in trauma.”
Continuing to prioritise the development of their own skills and knowledge is also important if nurses are to lead the efforts to create a value-based NHS. Nurses will need to develop competencies in “healthcare financing, budgeting, resource allocation and strategic planning”, says the ICN, and “be adequately prepared to help shape policy, work effectively in interdisciplinary teams, plan and manage health services, involve communities and key stakeholders in healthcare planning and delivery and lobby for increased resource flow to health systems.” Even if successful at lobbying for mandated safe staffing levels, writes one US- based medical-surgical staff nurse, Pamela Tevington, in ‘Mandatory Nurse-Patient Ratios’, “much more work [will be needed] by the nursing profession for its successful implementation.” Most importantly, nurses will need to obtain the “political knowledge and power employed by other powerful special interest groups to ensure their employers will be held accountable for obligations imposed on them by governmental laws.”