Academic journal article Care Management Journals

Home Care and the New Economy: Creating a New Model for Service Delivery

Academic journal article Care Management Journals

Home Care and the New Economy: Creating a New Model for Service Delivery

Article excerpt


The home health care industry has experienced steadily increasing challenges to its service delivery in recent years. Changes such as intensified competition, declining reimbursement in the face of escalating costs, and demands for improved outcomes and client satisfaction have led organizations to seek ways to effectively deliver service in this new environment. To achieve this, an organization must pinpoint what doesn't work. As stated by Hammer and Champy (1993), one possible definition of success is an organization's ability to reinvent how it does business.

Several years ago, a cross sectional representation of staff joined with the senior management of the Visiting Nurse Service of New York (VNSNY) to strategically plan not only for its survival, but how to maintain and improve its clinical excellence in the new millennium. As a result of that meeting, VNSNY recognized the need to deliver service in a new way, if it were to remain competitive. It was essential to do more than just fix numbers to reduce the size of geographic service areas or increase the number of staff. In order to get new results, it was agreed that the plan must consider a complete redesign of the existing way of delivering service. Hence, an agreement to create a new Service Delivery Model (SDM). The goals of the model were to reduce service costs, enhance clinical quality and outcomes, and improve patient and staff satisfaction.

Shortly thereafter, a work design group was formed to study organizations both within and outside of the health care field, specifically seeking those that had innovatively responded to changing market conditions. The work group's efforts steered them in the direction of "reengineering" in the workplace. "Reengineering" is a topic that has been extensively documented in health care, primarily in hospital systems. Several examples are available within the home health care arena (Christiansen, 1997, presentation; Davis, 1997; Williams, Seago, & Conn, 1996). All of these models discuss the redesign of home health care work teams. The work group found common elements: a focus on the patient/customer satisfaction, the self-directed nature of the team, common goals, multidisciplinary membership, and an emphasis on patient outcomes.

The work group invited Kathryn Christiansen, Executive Director and Administrator of Rush Home Care Network, Chicago, IL, to discuss her organization's "Interdisciplinary Care Team Model," which became the design that provided direction for the work group. The work group also interviewed several consultants to help assist the organization in the design and implementation of the new SDM. Innovation Associates, a subsidiary of Arthur D. Little Consultants, was selected for its systems approach to change and well-known work in building "learning organizations" (Senge, 1990).

These consultants first assessed VNSNYs structure, systems and organizational culture. Next, they developed a detailed work plan for the implementation of the SDM. A network of various action teams was created: these teams completed the plan for implementing an interdisciplinary team model. In this paper, the components of the SDM are discussed in detail. SDM was and is "a work in progress."

The VNSNY model is not an identical replica of any of the models that were studied prior to its design. However, important strategies will be highlighted that emerge as the design and implementation of this model are discussed. These strategies include:

* Aligning the strategic goals of the organization with the work of the clinician;

* Facilitating teams working together to achieve results;

* Redefining the work of the team to include continual improvement; and

* Supporting team learning.


So, what is the SDM? To summarize it simply, VNSNY believes that how people work together significantly influences the achievement of patient outcomes. …

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