Healthcare Transformation:Advances, Retreats, and Strategy

for Nurse Practitioners

NONPF 38th Annual MeetingCharleston, South Carolina

April 12, 2012

Michael R. Bleich, PhD, RN, FAANDr. Carol A. Lindeman Distinguished Professor of Nursing

Healthcare Transformation is Serious Business

Advances, Retreats, Strategy

Advances are real: Workforce Public acceptance Enhanced roles Scope of practice Educational standards Science‐base for 

practice

Retreats are equally real: Workforce imbalance 

with public need Infrastructure issues Contextual knowledge 

of the system lacking Cohesion within the 

discipline Public knowledge

The Role of Strategy: NONPF

An organization's or discipline’s process of defining its strategy, or direction, and making decisions on allocating its resources to pursue this strategy within the context of the current environment to meet future demands 

Strategy Requires Context and Voice, but also Energy and Responsiveness

Passion Messaging Risk taking Tenacity Clarity of purpose Strength of character

WHERE AND HOW DO WE USE OUR VOICE? Policy tables?  Public awareness? Teaching students? Are we insular?

Nursing defined – (Bleich, AHNA Beginnings, February, 2012, p. 5)

“Nurses must unify to express this message:  we are the sole health discipline that approaches health, disease, illness and chronic care management with knowledge drawn from a model of holistic care.  We make decisions, provide and orient treatments, and take other critical actions based on independent observations and team‐based plans.  We are the sole discipline that hardwires the perspective of the patient/client within the context of family and community, and care is coordinated and managed according to this context.” 

Each discipline has a lens from which they “see” and assist the patient . . .

Physician: science of disease & cures

Physical Therapist: mobility expert

Nursing: holistic, health & disease, family & community

Psychologist: individual therapy of the mind/meaning

Pastoral care: for the spirit

Social worker: family therapy & social support

Three Strategic Foci for NPs NOW!

1. Revolution through Education:  Student and Public Education

2. Revolution through Practice:  Engagement with ACO development

3. Revolution through Science: Clinical focus must expand to organizational systems and policy analysis and critical thinking must be combined with critical action!

IOM Roundtable on Value & Science-Driven Health Care Culture Design & processes Patients & the public Decisions Care Outcomes & cost Knowledge

Health information The data utility Digital technology Trust fabric Leadership

Seven Complex Lessons in EducationFor the Future

Blind spots of knowledge: error and illusion

Principles of pertinent knowledge

Teaching the human condition Edgar Morin

Seven Complex Lessons in EducationFor the Future

Teaching Earth identity

Confronting uncertainties

Teaching comprehension

Ethics of the human genre

Edgar Morin

Graduate and Doctoral Education in Health Sciences and Health Services

Crucial Conversations about the level of R & R (rigor and relevance)

Crucial Conversations about pedagogy and shift in the mental models that students bring to the academy

Crucial conversations about the shifting realities in health care and academic economics

Crucial conversations about where science and inquiry need to go

The Report STRATEGIC BLUEPRINT:Scope of PracticeLifelong LearningAdvancing Education for Societal BenefitWorkforce DevelopmentExpanded CompetenciesFULL partnership with physicians & others in redesigning the healthcare system

Visit http://www.iom.edu/nursing to view the report 

This is YOUR time – this is a time for CLARITY –and the other Traits the Define Being a

REVOLUTIONARY!

Analytics & Nurse PowerAccess and Reporting

What happened?        (standard reports)

How many, how often, where? (ad hoc reports)

Where is the problem? (query/drill down)

What actions are needed? (alerts)

Analytics

Why is this happening? (statistical analysis)

What if these trends continue? (forecasting/extrapolation)

What will happen next? 

(predictive modeling)

What’s the best that can happen? (optimization)

Analytic Stages Model

Analytically impaired

Localized analytics

Analytical aspirations

Analytical companies (schools?)

Analytical competitors

(Davenport and Harris, Competing on Analytics)

Analytics and a Reformed Health SystemREQUIRES:

PhD/DNPs who can: Doctoral Level expertise to answer:

Engage with other organizational, statistical, and complexity scientists

Shape clinical care delivery systems

Enter into the organizational decision‐making arena

Why is this happening? 

What if these trends continue? 

What happens next?

What’s the best that can happen?

Implications for Doctoral Graduates:

Not stand‐alone

Contributes  to the value 

chainCreates return on investment

Creates  tangible assets

Benefits  patients and organization

Knowledge and Research

We Are Called To:

Innovate! (even more!)

Evaluate! (even more – add economics and analytics and the public perspective)

Integrate! (with the re‐forming health system)

Communicate! (by testing for all scenarios – urban, rural, frontier)

Convergence and Forward!

The convergence of decades of hard work, growth in our science, linkage of academic‐service technology with the human condition, and health policy can reinvigorate our purpose for being nurses.  Let us converge our energy for the sake of good.

Contact InformationMichael R. Bleich, PhD, RN, FAANDr. Carol A. Lindeman Distinguished Professor

Oregon Health & Science UniversitySchool of Nursing – SN‐ORD3455 SW US Veterans Hospital RoadPortland, OR  97239‐2941Phone: 503‐494‐7445Email:  bleichm@ohsu.edu