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Rehabilitation Nursing's Responsiblity in Shaping the Future U.S. Health System
Whenever illness or injury occurs, everyone wants to receive the best possible care. Recently, The Commonwealth Fund Commission on a High Performance System released the National Scorecard on U.S. Health System Performance 2008. This report reveals that compared to international performance benchmarks, the U.S. system once again falls well below acceptable standards (it was awarded an overall score of 65 out of a possible 100). In terms of efficiency, the United States ranks 53 out of 100 on measures identifying inappropriate or fragmented care, avoidable costs, inadequate delivery of recommended preventive care, variation in quality and costs, and insufficient use of information technology. According to this report, the United States spends twice per capita what other industrialized countries spend on health care and is projected to soon spend $1 for every $5 of national income (Commonwealth Fund Commission on a High Performance Health System, 2008). So why are we in such a negative predicament? What can realistically be done to immediately begin reversing these trends?
Although the United States falls short on many performance measures, access and efficiency of care remain two major stumbling blocks. In addition, the United States now unfortunately ranks last out of 19 countries for mortality responsive to medical care and actually fell from 15 to 19 during the past 2 years.
While change cannot occur overnight, inaction and apathy are not options. Healthcare providers, insurance providers, legislators, and consumers alike must accept accountability for our healthcare situation and work more productively to find solutions. Blaming or pointing the finger are not productive solutions and will just perpetuate the downward spiral. Data-based decision making is essential as we move in a more positive and uncharted direction.
When reviewing the many elements that need improvement, it is apparent that rehabilitation nurses serve in a leadership position and are role models for finding ways to move health care forward. Within rehabilitation, the team approach forms the structure for each patient’s coordinated, individualized, and follow-up care—qualities that are frequently lacking in the general healthcare environment. The result of this unified approach is much more patient-centered and timely care with discharge planning that is consistently tailored according to realistic patient and family needs, capabilities, and resources. For instance, recovery after stroke is a complex process. It encompasses the interplay of the pathophysiologic and psychological processes directly related to the stroke (including the associated comorbidities), the effect this health condition has on the stroke survivor and his or her family, and preventative problems (e.g., falls, skin breakdown, contractures). Given our multiple success stories involving a myriad of patients with acute and chronic problems (i.e., traumatic brain injury, cancer, amputations, multiple sclerosis, stroke) who transcend what appear to be insurmountable obstacles, rehabilitation professionals need to share their outcomes more consistently with the media, legislators, insurance providers, and the general public.
This is not a time to be timid as a professional group. As we all know, rehabilitation nurses are able to see the strengths and possibilities for our patients and their families rather than the obstacles and limitations. We concentrate on promoting independence and the highest quality of life, but also frame our approach with a blend of increased patient access to needed services, evidence-based practice, tenacity, flexibility to redirect resources as needed, and creativity as we provide coordinated care. In addition, as a professional organization and practice group, rehabilitation nurses are more sensitive to best practices and early emphasis on rehabilitation as appropriate, expanding the scientific base and evolving skills associated with our practice, and the importance of timely and comprehensive documentation of what has been accomplished and what remains to be achieved. Just as we consciously cultivate a greater sense of confidence, partnership, accountability, creativity, resource building, and caring with our patients and their families, so too must we expand those actions that energize our colleagues and other stakeholders. The dividends could be improved quality and efficiency of care, positive patient and family outcomes, and enduring effective partnerships.
Rehabilitation nurses may not have all of the answers to redress healthcare delivery inadequacies; however, as indicated by the articles in this issue, rehabilitation nurses possess a broad array of expanding skills and knowledge that enhance care delivery from basic proficiencies to cutting-edge practice. Moreover, with the journal now online, greater numbers of health professionals and other stakeholders will have easier access to what is occurring in the field of rehabilitation.
The U.S. health system needs to take an objective look at what is working well and immediately redesign those areas of critical deficiency. It is time to learn from the past and look toward the future. We need to clearly articulate measurable and achievable outcomes that demand accountability and effective partnering of all stakeholders to develop the quality healthcare system that we all want and deserve. The foundation of our practice consistently illustrates that rehabilitation nurses can transcend boundaries and will always strive to facilitate the highest possible performance.
The Commonwealth Fund Commission on a High Performance Health System. (2008). Why not the best? Results from the National Scorecard on U.S. Health System Performance 2008. Retrieved August 13, 2008, from www.commonwealthfund.org/publications/publications_show.htm?doc_id=692682.