¶ … ambulatory care facilities are now performing the majority of surgeries in the United States today, this is most likely the result of a combination of free market will and government influence. Callard (2012) notes that one major trend is that more complex and high-end procedures are being moved to an outpatient setting. This trend in particular has its roots in the power of the market. Callard notes that it is payers who are driving this move to the outpatient setting, and they are doing so for a couple of reasons. Obviously, cost is the most important reason. It typically costs less for surgeries to be performed outside of the hospital, and patients are often released more quickly, reducing the costs associated with long stays. This demand for more procedures to be performed in an outpatient setting is encouraging more such facilities to offer operations. While some, like endoscopy clinics, have offered surgeries for years, others are beginning to improve their ability to deliver such services, in response to market demand. Patients also prefer outpatient surgeries, because they spend less time away from home and the entire experience is considered to be more comfortable. Given that both payers and patients support this trend, it is expected that the trend will continue for the foreseeable future. The other major influencer, however, is government, and that legislative environment surrounding surgeries is also something that is in a state of flux, given the Affordable Care Act. For some companies, this means more revenue, not less. For example, the ambulatory surgery center industry stands to gain from provisions in the Affordable Care Act that will improve access to colorectal screenings, which are usually in the form of a colonoscopy (No author, 2012). Thus, the changing environment encourages these facilities to enter the surgery business.

The overall effect on the quality of care is something that can only be speculated. Surely, those who stand to lose from current trends will argue that the quality of care will decline, and those who stand to gain will argue that they deliver a higher quality of care. In many cases, such as with colonoscopies, increased access to the procedure is more important from the patient's perspective, since such procedures can save lives. However, the issue is still undecided, as the trend is still ongoing.

Student #2. The trend towards more surgeries being performed in an ambulatory surgery environment is driven by the payers and the government. Both insurance companies and government are seeking to reduce the costs associated with surgical procedures. As a result, they are working to push for such procedures to be moved out of hospitals and into ambulatory facilities. Those who are paying for the procedures are therefore primarily responsible for setting the terms and conditions of those procedures, and this includes having them performed outside of hospitals.

The trend is towards cost-savings, so the move to more efficient facilities in inevitable. Callard (2012) notes that ambulatory care facilities are set to tackle more complex surgeries, highlighting the direction and strength of the trend. It is worth considering, however, that those facilities may not be capable of managing the most complex surgeries efficiently. The trend, if driven by economic efficiency, will have its limits at the point where the surgery is non-routine to the point where it does not make sense to have it performed at an ambulatory care facility. The standard of care overall should improve with this trend, since surgeries will be performed at the facility most suited for them.

Question #2. Fields (2011) notes that work overload is affecting most positions within the health care industry, but the nursing position in particular. Nursing overload, particularly of administrative tasks, contributes...

This creates what is known as a negative feedback loop, where negative things reinforce one another. Thus, it is important for health care managers to address the issue of nursing work overload.
One key solution to the problem is to have staff who can handle these tasks. Many tasks, especially on the administrative side, fall to nurses almost by default. The problem, however, is that health care facilities that seek to control their costs will inherently seek to limit non-essential staff. Some proper accounting of the costs that putting all of this non-nursing work onto nurses would help, however. Right now, organizations assume that it is cheaper to offload the costs onto nurses, but turnover and training costs are very high, and it is sometimes difficult to find good people to fill open positions. Hiring more staff in the first place breaks that negative feedback loop and allows nurses to focus on their core job.

When challenging work conditions lead to turnover, this hints at a problem with respect. Therefore it is important that nurses are treated with respect, and that they are given positive feedback for a job well done. If tremendous amounts of work are being offloaded onto nurses, positive feedback and healthy pay will go a long way to retaining nursing talent.

Finally, adequate training must be provided. If non-administrative tasks are critical to the nursing profession these days, nurses need to understand that when they take the job. They need to be trained by the organization as to what is expected of the position, so that there is no issue with the type of work that is being delegated to the nurses. Too often, nurses graduate from their nursing school thinking that their role is primarily to perform the medical function, creating an unrealistic expectation of what the job actually is. Better training can communication would alleviate that (Gaspar, 1991).

Student #2. A Chief Nursing Officer, I would address the problems associated with work overload among nurses primarily by reducing this work overload. This can be done a few different ways. Fields (2011) notes that wages are too low, and there are too few staff. These two factors contribute to a significant amount of the overload in the nursing profession. Thus, the first solution that I propose is to increase wages. Certainly, higher wages make professionals worry less about their working conditions. This is not universal, but the better that the pay is, the more willing employees will be to tackle the most complex jobs.

The second recommendation is to hire more staff. Clearly, nurses are doing work that they are not supposed to be doing. This needs to change, and the result will be that nurses can go back to focusing on nursing, and new administrators can focus on performing those tasks. The third recommendation is there is not enough training. Nurses have trained to perform medical tasks, and can be frustrated when asked to perform more menial tasks for which they have not been trained. The solution is to improve their training for these tasks and their understanding that such tasks are important to the role.

Question 3. Both of these questions are interesting. They address some of the complexities of modern hospital administration. In doing these questions, I received a broad overview of the issues that health care administrators are facing today. One complaint, I suppose, is that neither question went too in depth about either of these problems. They are complex issues and the solutions are not always as easy as can be explained quickly. For instance, when the proposed solutions cost more money, how does this reconcile with the environment where the payer and the government are seeking to cut costs? There are other similar issues, like where can one find quality nursing administrators to take the slack off of nurses? So it was a bit disappointing that some of the real world logistical issues were not addressed in these questions.

Overall, however, I feel that the questions do allow me to think about some of the issues that are at…