Patient issues have become more complex recently, and a strain on the healthcare system has increased significantly. Bower (2016) suggests several reasons for these changes: aging of baby boomers, a growing number of people with chronic illnesses, a dramatic increase in outpatient surgery, and a greater reliance on self-care. Under these circumstances, care coordination has become an essential issue within the healthcare system. Care coordination refers to the synchronization of patient care delivered by different health care providers and professionals. It involves organizing resources and activities and ensuring communication among various specialists engaged in treating a particular patient. The results of effective care coordination include improved patient outcomes, decreased readmission rates, reduced healthcare costs, and overall positive patient experiences. Nurses are the key agents in this process because they are directly involved in providing patient care. Therefore, it is essential for them to be familiar with the care coordination basics that will be discussed further.
Strategies for Collaborating with Patients and Their Families
Effective care coordination requires healthcare professionals to collaborate with patients and their families to ensure successful patient progression and transitions across different settings in the continuum of care. Menear et al. (2020) propose several effective strategies that can be used to engage patients and their families in patient care. The first strategy is patient education that aims at increasing patients’ knowledge or changes their attitudes in order to improve health outcomes or prevent illness. Patient education may be delivered verbally or with the help of written or electronic tools. Another effective strategy described by Menear et al. (2020) is patient navigation, the purpose of which is to inform patients and their families about the health and social care system and services available to them. This is an important strategy since it helps patients navigate the complicated healthcare system, improves communication within the system, and facilitates patients’ access to care.
Care coordinators should pay particular attention to cultural competence strategies. Brown et al. (2016) argue that cultural differences may lead to conflicts between patients and practitioners regarding medical issues. The researchers emphasize the importance of building rapport and becoming familiar with patients’ beliefs and values to avoid cultural misunderstanding (Brown et al., 2016). Healthcare professionals should address patients’ and their families’ trust concerns and identify their specific needs before making healthcare decisions. As for decision making, Brown et al. (2016) stress that it should be a shared process in which evidence-based decisions of practitioners should be aligned with patients’ informed decisions. Shared decision making is an effective strategy for collaborating with patients and their families that emphasizes patients’ autonomy and helps in care coordination.
Patient-Related Aspects of Change Management
Healthcare facilities are often faced with an organizational change of a large scale. While these changes present substantial challenges to healthcare administrators and other employees, patients’ experiences during change implementation should also be taken into consideration. The case of Vanderbilt University Medical Center (VUMC) described by Carlson et al. (2019) demonstrates how healthcare organizations can mitigate negative effects experienced by patients during a large-scale organizational change. During the implementation of new electronic health records, VUMC identified aspects of change management that were visible to patients. In order to address patients’ concerns or negative experiences related to change, the healthcare facility informed patients about the oncoming change and included patients in the planning process. VUMC also collected feedback from patients to adjust the change to patients’ needs. Communication with patients during change implementation is essential, and employees should be trained to put patients’ concerns first even at the time when they themselves feel stress because of change.
Coordinated Care Plans Based on Ethical Decision Making
Healthcare professionals are often faced with ethical issues and dilemmas when it comes to decision making. One of the most common ethical issues that care coordinators encounter in their practice is privacy and confidentiality. Care coordinators have to communicate with different healthcare specialists to collect and share information about patients for developing coordinated care plans. Therefore, they have to make sure not to disclose patients’ confidential information to third parties. However, according to Strom‐Gottfried (2019), care coordinators are sometimes faced with an ethical dilemma of breaching patients’ privacy when there is a serious threat to patients’ health or life. For example, if a patient does not receive treatment because his relatives prevent him from doing so, care coordinators may reveal some confidential information to make a case for neglect.
As a rule, care coordinators, as well as other healthcare professionals, should follow their professional code of ethics that guides their ethical decision making. However, since no code of ethics can be comprehensive enough to cover all ethical issues emerging in healthcare settings, care coordinators should rely on ethical theories and principles when making decisions. Strom‐Gottfried (2019) mentions such major ethical theories as deontology and utilitarianism. Care coordinators applying deontological ethics would make decisions based on rules, laws, and universal moral principles, without paying attention to consequences. Utilitarian decision making, on the contrary, is concerned about what actions would bring the most positive consequences to the greatest number of people. Finally, care coordinators should make decisions based on ethical principles of autonomy, nonmaleficence, beneficence, and justice. An ethical approach to care allows care coordinators to explore all possible options and their outcomes and make informed and critically examined decisions.
Impact of Healthcare Policy Provisions on Patient Experiences
Care coordinators should be aware of any policies that are relevant to patient care. One such policy is the health insurance provision of the Affordable Care Act (ACA). Since the ACA intends to increase access to health insurance for low- and middle-income individuals, it has a positive potential impact on outcomes and patient experiences. According to Kominski et al. (2017), the policy provisions have already increased enrollment in Medicaid and private insurance and reduced the percentage of uninsured. The researchers also found that Medicaid expansion also led to an increase in physician visits and the use of preventive care by low-income individuals. Kominski et al. (2017) explored the influence of Medicaid expansion on patient health outcomes and discovered an increase in rates of diagnosed diabetes and high cholesterol. It may be expected that other improvements in health outcomes will manifest themselves in the future.
Although health insurance expansion has certain positive impacts on patient experiences, it still has some flaws. For example, Kominski et al. (2017) argue that some individuals cannot use expanded health insurance because of such barriers as perceived cost of coverage, difficult enrollment process, and limited awareness of the policy provisions. Apart from that, a large number of low-income individuals reside in states that have not introduced expanded health insurance, so they still experience limited access to care. Care coordinators could increase the benefit of expanded health insurance for patients by informing them about eligibility criteria and enrollment procedures and helping them receive the coverage.
Nurses’ Role in Care Coordination
Nurses have a vital role in the coordination and continuum of care since they are directly involved in providing patient care. According to Bower (2016), nurses are responsible for identifying patients’ care coordination needs and aligning them with available resources. Apart from that, nurses should create plans for various cases, such as a physician visit, treatment duration, and financial resources needed to pay for the care. There is also a need for distinct coordination care plans for one episode of care and the continuum of care.
References
Bower, K. A. (2016). Nursing leadership and care coordination. Nursing Administration Quarterly, 40(2), 98-102.
Brown, E. A., Bekker, H. L., Davison, S. N., Koffman, J., & Schell, J. O. (2016). Supportive care: Communication strategies to improve cultural competence in shared decision making. Clinical Journal of the American Society of Nephrology, 11(10), 1902-1908.
Carlson, B., Agee, M., Smith, T., Sternberg Jr, P., & Morgan, J. (2019). Seven steps to successful change: How a large academic medical center prepared patients for organizational change. Patient Experience Journal, 6(3), 129-138.
Kominski, G. F., Nonzee, N. J., & Sorensen, A. (2017). The Affordable Care Act’s impacts on access to insurance and health care for low-income populations. Annual Review of Public Health, 38, 489-505.
Menear, M., Dugas, M., Careau, E., Chouinard, M.-C., Dogba, M. J., Gagnon, M.-P., Gervais, M., Gilbert, M., Houle, J., Kates, N., Knowles, S., Martin, N., Nease Jr., D. E., Zomahoun, H. T. V., & Légaré, F. (2020). Strategies for engaging patients and families in collaborative care programs for depression and anxiety disorders: A systematic review. Journal of Affective Disorders, 263, 528-539.
Strom‐Gottfried, K. (2019). Ethics in health care. In S. Gehlert & T. Browne (Eds.), Handbook of health social work (3rd ed., pp. 39-70). John Wiley & Sons.