The industry of health care has undergone fundamental alterations in the last twenty years; these changes have a great impact on patients as compared to workers. The relationship between specific changes in workforce; therefore, the quality of health care delivery, specifically, patient outcomes must be fully understood. This is because health care industry is the one where consumers are untrained and require making informed judgments or choices. This paper will explore the relation between staffing, level of skills, and the quality of services to the patients. The health professions and occupations regulation becomes an essential component in understanding this relationship. This is explained by the skills level specification, the influence on labor costs and supply as well as the assumptions in regards to the public protection.
The health care industry restructuring refers to the numerous changes within the organization in areas like ownership, health care providers regulation, and more importantly, in health care delivery services. Some of the factors that are likely to sustain this dramatic situation include cost concerns, advancement in technology, increasing competition, social attitudes that constantly change, aging population, and influence of investor priorities.
The most important organizational changes regarding health care industry have been in existence in the past twenty years. These changes have affected the health care and patients by moving from hospital-based health care to outpatient-based care and home nursing; corporate restructuring such as horizontal and vertical integration; an increase of the number of for-profit providers of health care; and the move to managed care. In that regard, visits community hospital declined by roughly 8 per cent between 1985 and 1955, while the outpatient visits increased by approximately 90 per cent during this period (AHA 99). Additionally, a lot of care is provided in non-hospital places like patient’s homes, physician’s offices, and outpatient clinics. According to Alexander and Fennel (111), “increase in organizational diversification kinds and products being used in health care industries, the vulnerability of hospitals have immensely decreased the uncertainty in the inpatient care sector”. This is because of the broadening of its activity.
The changes in terms of ownership is another area that has greatly affected the management, thus making hospitals form mergers and ignore the patient care while maximizing on the profits. In 1995, roughly 15 per cent of medical institutions were investor-owned, up from approximately 13 per cent in 1994 (AHA 96). Among the 10 largest hospitals in the USA in 1993, 3 were state owned while others were for-profit institutions (Reardon and Reardon 1067).
Increasing complex inter-organizational patterns have undergone evolution process, and most hospitals have been forced to form collaborations with the aim of offering care organizations particular service for their esteemed patients. This is also aimed at improving efficiency while lowering the costs of health care to patients. According to American Hospitals Association’s (AHA 106) Yearly Survey of Hospitals, 30 per cent of community medical institutions were integrated in health sector in 1995, up by 6 per cent from 1994 (AHA 71). Towards the end of the year 1995, AHA (1996) reported that 48 per cent of urban hospitals had become a part of health care system or joint ventures and some other contractual arrangements. Most of these arrangements were aimed at increasing the profits while ignoring the quality of health care delivery to patients. Changes in regards to patient care and service delivery remain fundamental in the process of re-engineering internal organizations to increase the efficiency, improve patient satisfaction, and save money.
Impacts of Health Care Industry Changes
As policy and decision-making within health care industry embraces changes and moves from individual doctor/patient relationship to changes in service delivery, attention must be given to the quality of care provided to the patients. Through collaborations, health care organizations become capable of measuring the quality of health care. This is achievable through developing formulas for measuring the effectiveness of treatments for particular illnesses. Evaluating the skill mix and worked nursing hours per patient day to patient outcomes through data suggests that staffing threshold is related to quality patient care.
The Role of Staffs and Work Content
Dramatic change in staff mix is due to redesigning of the hospital work. This is usually done by increasing the number of RNs and decreasing the number of less-skilled staffs. This has affected the quality and the interest of nurses to care for the patients at an appropriate time. However, because cost pressures demand that patients are cared for in the least resource-intensive setting, hospitals are focusing on higher proportions of seriously ill patients and are caring only for patients when they are seriously ill or at acute phase. AHA (93) reported that part-time or temporary RNs have joined the full time job, and this is, in fact, an act of de-skilling the nurses. This does not assure continuity of care and the substitution of such nurses by permanent staff does not guarantee familiarity with specific units or institutional procedures within the health care fraternity.
The role of staffs in providing quality patient care and patient outcomes remains fundamental in the process of medical regulations. In this area, the focus is mainly on the structural measures and process measures. A series of studies of magnet hospitals provides insight into numerous impacts attributed to organization of nursing on quality of care as well as service provision. In 1982, the United States were particularly successful in attracting and retaining professional nurses that offered essential services when the country was faced with the problem of nursing shortages (Fennel and Alexander 89). This was extremely instrumental in ensuring continuity in patient’s care provision. The magnet hospital was identified as the best since it undertook infusion of hospital nursing with the values of excellence in nursing. This was extremely important in accounting for a huge difference in mortality rates.
Occupational Regulation: Relationship to Quality
Restructuring of health care system enables ancillary personnel to take on new roles for which they might have not received training and certification . The argument in regards to occupational regulation is based on protecting consumers through assurance of competence. This is based on the assumption that consumers lack the knowledge of making informed decisions concerning the quality of health care and the established standards. However, the Task Force on Health Workforce Regulation of the PEW Health Professions Commission concluded that regulatory system is unlikely to protect the consumers (Brinegar 7). For most health occupations, the relationship between the regulated system and quality assurance is still unclear. It is, therefore, evident that systems that consider giving rewards to professions are likely to affect the patients positively since they insist on cost-effectiveness, high quality, and accessible service delivery.
Secondly and finally, minimum education and competency is an area of concern. Measuring the educational attainment of nurses that leads to regulation of nurses or medical practitioners in the field assures successful competition. Successful competition receives approval and acceptance by the regulatory board since it clearly prevents incompetent persons from entering the occupation (Brinegar 10). In order to improve the quality of health care delivery, practical skills training is more vital than focusing on regulating medical professionals, which affects the quality of health provision negatively and, to some extent, positively.
Affects of medical regulation on patient care are diverse. This is because it affects both the health care and the quality of health care provision to patients. As much as there are numerous positive aspects of medical regulation, there are negatives aspects too. Therefore, it is important for medical fraternity to invest in practical skill trainings to ensure that there is assurance in terms of regulations, efficiency, and quality care to the patients.