Implementing National Strategies at the Local Level
Success in implementing national health policies at the local level requires that resources and people are committed toward a common goal. This is an interactive process with several distinct phases and with opportunities to be influenced by decision makers at each stage. Specifically, a policy goes through the phases of formulation, implementation, evaluation, and modification (Abood, 2007). At each point, there are risks to the project’s implementation; risk of losing funding, failure to define the scope of the project adequately, lack of clear objectives and deliverables or failure of infrastructure and support systems. Perhaps most crucial in implementing national healthcare policies at the local level is enlisting the support, buy-in and ongoing commitment of providers of care who are familiar with regional issues.
In the case study, “Introducing Evidence-Based Practice in Mental Health in North Carolina” (McLaughlin & McLaughlin, 2008), the state of North Carolina attempts to induce changes to its mental health delivery system by introducing evidence-based practices into its clinics. Their success, however, is limited in part because of lack of ownership at the local level as well as absence of understanding at the national level to support implementation of the policies. An analysis of this case study also reveals that differences exist between clinical knowledge and practice in the field of mental health versus the concept of more formal evidence-based practices as dictated by outside agents at the national level. Gaps between the evidence-based claims of a national mental health policy and how those services are implemented at the local level also become apparent.
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...y initiatives will fail if they are not supported and adapted at the local level and by the practitioners responsible for the delivery of care.
Works Cited
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Evans, B., Snooks, H., Howson, H., & Davies, M. (2013). How hard can it be to include research evidence and evaluation in local health policy implementation? Results from a mixed methods study. Implementation Science, 8(1), 1-9. doi:10.1186/1748-5908-8-17
Kavey, R. (2009). Leadership commitments to improve value in healthcare: Finding common ground. Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK52843/
McLaughlin, C. & McLaughlin, C. (2008). Health policy analysis: An interdisciplinary approach. Boston, MA: Jones and Bartlett Publishers.
Safriet identified several barriers to the removal of these restrictive practices include (1) lack of awareness of APNs roles and abilities, (2) purposeful or inertial retention of the dysfunctions resulting from historical evolution of our state-based licensure scheme and (3) organized medicine’s continued opposition to expanding the authority of other providers to practice and be paid directly for the services.
Tillett, J. (2011). Practicing to the full extent of our ability: The role Nurses in healthcare reform. The Journal of Perinatal & Neonatal Nursing 25(2), 94-98. Doi: 10.1097/JPN.0b013e318217ed3c
Shi L. & Singh D.A. (2011). The Nation’s Health. Sudbury, MA: Jones & Bartlett Learning.
Longest Jr., B.B (2009) Health Policy making in the United States (5th Edition). Chicago, IL: HAP/AUPHA.
In the early years of 2009 to 2010 the political process pushed health care through legislation led by Senate Majority Leader Harry Reid (Health care and government, 2013). This process was extraordinarily tiring, as many defenders of the bills passing were present. Many congressional members “dug their heels in”, and wanted to slow down the process even more as confusion about the bill was posed (Health care and government, 2013). Despite opposition by many sides of the American people, a Democrat-dominated House of Representatives passed the bill and the Affordable Care Act was signed into action on March 21, 2010 (Hogberg, 2013). Indeed, all three branches of government were instrumental with the passing the Affordable Care Act into place.
Nurses are active, they see policies as what they can restructure or change, instead of taking it as what has been imposed on them. They are involved in policy development as well as working together as one profession. As nurses, they participating in decision making regarding health policies, as well as taking part in implementations associated with changes in health care. Currently, nurses are serving “on advisory committees, commissions, and boards” (Cohen, M. & Walker, A. 2010). Policies and decisions in these areas will help to advance patient care in health
Feldstein, J.P. (2011). Health Policy Issues: An economic perspective (5th ed.). Chicago, IL: HAP &AUPHA.
Successful health care organizations succeed because their leaders are able to identify technical and adaptive challenges, and then strategically adapt to these challenges. Health care organizations who fail miserably, fail because their leaders do not have the ability to adapt as well as notice the heat temperature boiling in their organization. The harder they push the harder they fall. The health care organization and health care system that most exemplify this failure is Care Group health system and its joint hospitals BID (Beth Israel & Deaconess Hospitals). Beth Israel Hospital (BI) and Deaconess Hospital both started as profitable hospitals; each having their own culture and own business models.
Like Klinger, Hitchcock agreed that in a managerial role is essential and performs a vital function, leadership must come first to make managing more effective. If management is efficiency in climbing the ladder, then it is leadership that determines whether the ladder is leaning against the right wall. To help individuals, teams and organizations to navigate the permanent white-water environment safely, Hitchcock (2013) suggested that there are three constants that provide stability in times of great uncertainty such as a change, a choice, and principles. This work considers each of these three constants, focusing mainly on the principles that underpin transformational and effective leadership in healthcare settings. (Hitchcock, Klinger, 2012)
Why now? Why are we focusing on transformational leadership? Healthcare costs are continuing to rise. Some of the critical problems and active debates prevalent in many hospital organizations include the rapidly intensifying healthcare costs, funding and reimbursement cutbacks, and concern regarding the overall quality and safety of health care. “Healthcare systems have come under pressure to improve performance and manage productivity” (Botting, 2011). To be successful in the 21st century, there is a demand on healthcare systems to have a vision and executive and clinical leadership to inspire the change process and make the difference between success and failure in change.
Community is a population aggregate, inhabiting a territory, integrated through common experience, possessing a number of basic service institutions, conscious of its local unity and able to act in a corporate capacity.
A manager’s leadership style must influence staff and others to take them seriously. A manager sets the tempo for the employees’ work ethic. Effective leadership from healthcare managers is important to the modern healthcare reform (Kumar, 2013). Leadership engagement in healthcare explains how a problem could affect a healthcare organization. Managers that hold leadership roles must adopt a certain style that can be functional for his or her initial organization to be successful. Performance improvement can be a very serious aspect of leadership engagement (Croxton, 2011). Healthcare managers need to have people from all areas involved to work effectively. Without the consistency of getting all staff and physicians involved, the organization may suffer greatly.
Health care policy targets the organization, financing, and delivery of health care services. The reason for targeting these areas is for the licensing of health care professionals and facilities, to make sure there is protection of patients’ private health information, and there are measures of quality care, mistakes, malpractice, and efforts to control of health care cost (Acuff, 2010). There are several stages that one must take when creating a policy (see figure 1). The figure below shows the critical steps in the policy process. First, the problem must be identified, once the problem is identified potential policy solutions must be formulated, then the policy is adopted, and then implemented. After the policy is in place, an evaluation of the policy has to take place (This Nation, 2013).
Public Health Nursing (PHN) aims to improve the wellbeing of the population by promoting health and preventing disease among all people in the communities (Public Health Nursing, 2013). The PHN utilizes the primary, secondary, and tertiary prevention to help improve the health of the communities. The PHN process is applied to all levels of practice. Interventions are “actions take on behalf of individuals, families, systems, and communities to improve or protect health status” (Stanhope & Lancaster, 2012, p. 191). This paper will identify PHN interventions such as screening, outreach, and referral and follow-up, health teaching, and counseling that was identified in the PHN in the 21st Century project that this author completed as part of the PHN experience. This paper will also identify if the interventions were at the community, system or individual/family level.
Leadership in the medical field is vastly overlooked. Many people view leadership in medicine as a rise in ranks, in positions of power within a hospital or organization. They look at it as personal gain, a title, and less like a chance to actually lead anything, to actually impact anything. Since taking these leadership course, I’ve come to view leadership in the medical field more like the model I recently learned about, Komives’ and Wagner’s Social Change Model of Leadership. In their book Leadership for a Better World: Understanding the Social Change Model of Leadership Development, ...