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Best Care at Lower Cost: New IOM Report Spotlights Crucial Role of Nurses

September 6, 2012

By Mary D. Naylor, PhD, FAAN, RN. Dr. Naylor is the Marian S. Ware Professor in Gerontology and director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania School of Nursing. She is also the National Program Director for the Robert Wood Johnson Foundation program, Interdisciplinary Nursing Quality Research Initiative, aimed at generating, disseminating, and translating research to understand how nurses contribute to quality patient care. She was appointed to the Medicare Payment Advisory Commission in 2010. 

Building on the Future of Nursing report’s call for nurses to fully engage with fellow health care professionals, a new report from the Institute of Medicine, Best Care at Lower Cost, calls on nurses and others in the health care system to apply emerging tools, technologies, and approaches to yield lower costs and better health outcomes. I had the great fortune to serve as a member of the study committee.

The complexity problem. The report couldn’t be more timely or relevant, particularly for nurses and the patients they serve, given the complexity of the current health care system. Administrative and workflow inefficiencies limit hospital nurses from spending more than about 30% of their time on direct patient care. With increasing specialization, modern medicine now includes nurses in more than 50 specialties. To successfully coordinate a patient’s care, nurses need to communicate and collaborate with patients, family caregivers, physicians, pharmacists, social workers, and many other team members.

The complexity of patient care can blur accountability. Among hospital patients, 75% are unable to identify the clinician in charge of their care. Breakdowns in communication also can contribute to poorly coordinated care. As a result, almost one-fifth of Medicare patients are rehospitalized within 30 days, at a cost to Medicare of $15 billion in 2005 alone.

The ‘care team’ model. The report envisions a health care system with organizational cultures and incentives that prioritize leadership, team care, transparency, safety, and continuous improvement. And at the core of a continuously learning system is the care team, centered on the patient and comprised of family caregivers, clinicians and others involved in the patient’s care, within and between critical transitions in care settings.

What would a continuously learning health system mean for nurses? At every stage of patient care, nurses remain focused on the patient’s goals. They help ease the complexity, stress, and confusion of the health care system. When forming a care plan, they’re connectors who can help bridge clinical knowledge with a patient’s care needs. During a course of care, they’re explainers who can help patients understand and implement their care plan. And during care transitions, they’re facilitators, connecting the hospital, community, home, and other providers and services involved in the patient’s care.

Nurses are the common thread linking all components of a patient’s care, and are therefore also the key to advancing a less complex, less costly health care system. Continuously learning health care cannot wait.

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One comment

  1. The American Nurses Association applauds the Institute of Medicine (IOM) for its work in articulating what is not only necessary, but possible relative to development of a learning health care system that engages clinicians, researchers, and educators and is properly focused on patients. I am especially pleased to know Mary Naylor, RN, PhD, FAAN represented the voice of nursing throughout the process of developing this vision for an effective learning health care system. As Dr. Naylor stated in her summary, this report speaks to the need to address problems inherent in an increasingly complex health care system in a way that is critically important for the quality and accountability of patient care.

    The report’s recommendations provide a roadmap for change that challenges all health providers. Each day, patients and their families face the difficulties inherent in attempting to navigate an incredibly complex and fragmented health care system. Patients rightfully look to nurses to assist them in responding to these challenges. The changes proposed by the IOM committee will optimize the rapid capture and sharing of knowledge in a way that gives nurses the necessary tools to provide patients the assistance they need. This report also lays the foundation for making continuous learning a seamless and intrinsic part of American health care.

    Nurses have an opportunity to play a dominant role in the development of this learning health care system. A concerted system-wide investment in closing current gaps in our health IT infrastructure has the potential to promote more timely knowledge-sharing and provide nurses better access to clinical decision support systems that directly benefit patients and families. Placing higher priority on patient and family engagement around care quality and cost – including the need for clinicians to utilize new knowledge and provide timely information – are imperative if we are to succeed. Nurses’ partnerships with patients in roles as health coaches and care coordinators will contribute greatly to making this broad vision a reality.

    The current health care system needs reform on many fronts. This IOM report represents another clarion call and effort directed towards implementing those changes. Nurses’ education, knowledge and skills position us as necessary and integral contributors to this culture shift toward a learning health care system – one that recognizes and demonstrates the intrinsic value and need for nurse-patient partnerships that will improve the quality and accountability of care.

    Karen Daley, PhD, RN, FAAN
    President, American Nurses Association

    Editor’s note: sorry about the delay in approving this comment. For some reason it ended up in the spam queue. We appreciate your weighing in on this post!

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