Nursing Research

1. Discuss the concept of cost-based analysis. Provide an example of a program where it could be used to show outcomes.
The concept of cost-based analysis is delineated as the process for approximating all of the costs involved and the conceivable profits or benefits to be derived from a particular proposal. This analysis takes into account not only quantitative factors but also qualitative factors for examining the value for money for a particular project, proposal or opportunity. The fundamental aim is to make an ascertainment of any prospect and provide a basis for making contrasts and comparisons with other proposals. This concept of cost-based analysis can be significantly employed in different medical and health care programs, in order to reveal outcomes and results. For instance, within a healthcare institution, there are several different programs that are proposed in every fiscal year but not all can be accepted and implemented by the institution. Therefore, the most ideal approach of determining the ideal program is examining the entire cost expense of the programs and linking them with the benefit that will be expensed from it. For instance, different healthcare departments might propose the procurement of devices that cost a lot, such as MRI machines or dialysis machines. In this regard, the analysis would encompass determining the costs of procuring both machines and analyzing the benefits, for instance the number of patients requiring the machines (Frew, 2010).
2. Discuss a change theory and how it can be or has been applied in nursing practice to integrate care delivery sustainability.
One change theory that has been applied in nursing practice to assimilate care delivery sustainability is Lewin’s Change Theory. Established by Kurt Lewin, this theory is extensively employed in nursing and takes into account three phases including the unfreezing stage, moving stage and refreezing stage (Batras, Duff and Smith, 2016). This theory is reliant on the existent of driving and resistant forces. One the one hand, the driving forces encompasses the change agents who propel employees towards the direction of change. On the other hand, the resistant forces encompass the personnel or nurses who are against the propositioned change. An intervention of change and development within an organization is a sequence of practices, activities, and occurrences purposed to aid the entity in enhancing its performance and efficacy. However, despite the fact that change is inevitable, it is not always accepted or embraced completely. Imperatively, change is pivotal for the sustainability of the prison corporation, which positions the entity ready for transformation. However, with change comes resistance. In this regard, the fundamental resistance is expected to come in the form of personnel disliking their new roles, duties, and necessitated productivity (Welsh and Harris, 2016). In this case, the Lewin’s Change Theory can be beneficial in facilitating sustainability.
In particular, this theory has been applied in nursing practice to integrate care delivery sustainability (Batras, Duff and Smith, 2016). Numerous health care organizations have utilized Kurt Lewin’s theory to comprehend human behaviour with respect to change and patterns of resistance to change. When health care organizations entirely grasp and comprehend what behaviours impel or resist change, then work to reinforce the positive driving forces, change can take place positively. This theory has been incessantly employed to facilitate acceptance by frontline nurses by engaging them in all aspects of planning and execution. As a result, this creates independence and ownership of the introduced products, eventually giving rise to success (Sutherland, 2013).
3. New health care delivery models are being presented to accommodate the shift in health care objectives. Many of these models are community based and focused on improving quality outcomes, population health, and reducing readmissions to acute care settings. Describe a new health care delivery model and discuss whether or not it is sustainable.
In the contemporary setting, new health care delivery models are being unveiled to accommodate the change in health care goals and objectives. One of the notable health care delivery models is AdvocateCare (ACO), which is purposed to making reforms in the delivery system. In the initial six months since its establishment, ACO reported a decline in hospital stays and general costs, with the rate of hospital readmissions declining by 10.6 percent in comparison to the previous financial year and the number of emergency department visits declining by 5.4 percent. Imperatively, at the core of its model is a system network comprising of 4,000 physicians. A quarter of them are directly hired by the ACO, whereas the rest are in private practice. All of these physicians are measured against various initiatives that are in alignment to five key classifications that comprise of patient safety, health Information Technology, quality results, cost effectiveness and patient experience. Advocate physicians and their practices obtain report cards every financial quarter displayed online so there is a transparency of outcomes and physicians can perceive precisely how they measure up against their peers (Wren, 2012).
4. Two major models of care exist, for-profit and not-for-profit? Does one or the other provide more ethical care? Why or why not?
Within the healthcare system, there exists two fundamental model of care and these are the for-profit and not-for-profit models. In accordance to research conducted, for-profit healthcare model provides less ethical care. This is owing to the reason that there have been severe moral criticisms of for-profit health care that have been pronounced, both within and external to the medical profession. The most severe ethical criticisms for for-profit healthcare cab be perceived in six different ways. First, for-profit health care institutions are said to aggravate the issue of accessibility to health care. In a direct way, they do not provide healthcare to non-paying patients. Secondly, for-profit organizations constitute unfair competition against non-profit institutions. Owing to the competition they provide it becomes more challenging for non-profits to go on with their long-term practices of cross-subsidization. Cross-subsidization is of two distinctive kinds: nonprofits have conventionally bankrolled some poverty-stricken care by expanding the prices they charge for paying patients, and they have subsidized more expensive kinds of services by revenues from those that are less expensive comparative to the revenues they create (Brock and Buchanan, 1986).
The third reason for unethical perspective of for-profit models is that the treat health care as a commodity rather than a right. Fourth, for-profit healthcare models comprise of incentives and organizational controls that have a negative impact on the relationship between the patient and the physician, generate conflicts of interest that can deteriorate the quality of care and wear down the patient’s trust in his or her physician and the trust of the general public in the medical profession (Brock and Buchanan, 1986). The fifth reason is that for-profit organizations undermine medical education. There is substantial governmental sponsorship of medical education. It is extensively established that physicians do not recompense the full expenditures of their medical education. Conceivably then they have a shared duty well along to recompense back that subsidy, though it would need to be revealed why the form that duty ought to take is to provide free care to the poor in contrast to reimbursing the government directly. Lastly, for-profit healthcare models comprise of a "medical-industrial complex" that portends to utilize its great economic power to exercise unwarranted impact on public policy regarding health care (Brock and Buchanan, 1986).






References
Batras, D., Duff, C., & Smith, B. J. (2016). Organizational change theory: implications for health promotion practice. Health Promotion International, 31(1), 231-241.
Brock, D. W., Buchanan, A. (1986). Ethical Issues in For-Profit Health Care. Washington (DC): National Academies Press.
Frew, E. (2010). Applied methods of cost-benefit analysis in health care (Vol. 4). Oxford University Press.
Sutherland, K. (2013). Applying Lewin's change management theory to the implementation of bar-coded medication administration. Canadian Journal of Nursing Informatics, 8(1-2).
Welsh, W. N., & Harris, P. W. (2016). Criminal Justice Policy and Planning: Planned Change. Routledge.
Wren, A. (2012). Three Care Delivery Models Transforming Health Care. Optum. Retrieved 25 August, 2018 from: https://www.optum.com/resources/library/three-care-delivery-models-transforming-health-care.html