Domain 7: Systems-Based Practice

Domain 7: Systems-Based Practice

Descriptor: Responding to and leading within complex systems of health care. Nurses effectively and proactively coordinate resources to provide safe, quality, and equitable care to diverse populations. 

Contextual Statement: Using evidence-based methodologies, nurses lead innovative solutions to address complex health problems and ensure optimal care. Understanding of systems based practice is foundational to the delivery of quality care and incorporates key concepts of organizational structure, including relationships among macro-, meso-, and microsystems across healthcare settings. Knowledge of financial and payment models relative to reimbursement and healthcare costs is essential. In addition, the impact of local, regional, national, and global structures, systems, and regulations on individuals and diverse populations must be considered when evaluating patient outcomes. As change agents and leaders, nurses possess the intellectual capacity to be agile in response to continually evolving healthcare systems, to address structural racism and other forms of discrimination, and to advocate for the needs of diverse populations. Systems-based practice is predicated on an ethical practice environment where professional and organizational values are aligned, and structures and processes enable ethical practice by all members of the institution. 

Integrated healthcare systems are highly complex, and gaps or failures in service and delivery can cause ineffective, harmful outcomes. These outcomes also span individual through global networks. Cognitive shifting from focused to big picture is a crucial skill set. Similarly, the ability for nurses to predict change, employ improvement strategies, and exercise fiscal prudence are critical skills. System awareness, innovation, and design also are needed to address such issues as structural racism and systemic inequity. 

7.1 Apply knowledge of systems to work effectively across the continuum of care.

7.1e Participate in organizational strategic planning. 

7.1f Participate in system-wide initiatives that improve care delivery and/or outcomes. 

7.1g Analyze system-wide processes to optimize outcomes. 

7.1h Design policies to impact health equity and structural racism within systems, communities, and populations 

7.2 Incorporate consideration of cost-effectiveness of care. 

7.2g Analyze relevant internal and external factors that drive healthcare costs and reimbursement. 

7.2h Design practices that enhance value, access, quality, and cost-effectiveness. 

7.2i Advocate for healthcare economic policies and regulations to enhance value, quality, and cost-effectiveness. 

7.2j Formulate, document, and disseminate the return on investment for improvement initiatives collaboratively with an interdisciplinary team. 

7.2k Recommend system-wide strategies that improve cost- effectiveness considering structure, leadership, and workforce needs. 

7.2l Evaluate health policies based on an ethical framework considering cost-effectiveness, health equity, and care outcomes. 

7.3 Optimize system effectiveness through application of innovation and evidence-based practice. 

7.3e Apply innovative and evidence-based strategies focusing on system preparedness and capabilities. 

7.3f Design system improvement strategies based on performance data and metrics. 

7.3g Manage change to sustain system effectiveness. 

7.3h Design system improvement strategies that address internal and external system processes and structures that perpetuate structural racism and other forms of discrimination in healthcare systems. 

(American Association of Colleges of Nursing, 2021, pp.44-45)

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. AACNnursing.   https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf

Related Evidence

For the NURS 7111: Economics for Complex Organizations course, I and three team members were assigned a simulated quality improvement project based at the CHI St. Vincent Infirmary. Our team completed an assessment of the organization, a SWOT analysis, a needs assessment-GAP analysis, and a stakeholder assessment. This thorough evaluation prompted our team to recommend the initiation of an outpatient telehealth mental health service to improve access to mental health care and discharge follow-up treatments and plans. Our team then created key performance indicators and a feasibility assessment. We additionally identified regulatory mandates and  completed a force-field analysis, a risk and issues analysis, a detailed project task schedule, a detailed budget projections and financial plan including the identification of potential grants that could be applied for to assist in covering the cost of implementation, a cost-benefit analysis with implementation of the initiative as well as without the initiative, and a process evaluation.

For the NURS 7115: Clinical Prevention and Health Promotion course, I completed a group project with four fellow students. Our assignment was to design a health promotion program for Dallas County Arkansas. We first identified obesity, economic instability, and health care access as common health disparities in Dallas County. We then designed a health promotion program to mitigate these disparities within the county. 

The first step in developing this program was a thorough county description including the following: geography; demographics; schools and educational facilities; churches and community organizations; recreational facilities and community centers; health resources (hospitals, clinics, insurance); income and economics; and industry and employment. After completing the county assessment and formulating a community diagnosis, our team then developed our program objectives and determined our process of program evaluation. For the purpose of conducting our program design and implementation plan, we referenced the Health Promotion Model. Our plan included specific interventions aimed at reducing disparities and securing needed resources, such as financial resources, facilities, and team members. Finally, our group identified measures of evaluation of the effectiveness of our program and sustainability.

Reflection

 Both the CHI St. Vincent and the Dallas County Health Promotion Program were excellent learning experiences that not only contributed to my development of teamwork skills but provided exposure and experience in health care at the organizational level with an emphasis on the administrative role.

 The CHI St. Vincent project enabled me to achieve Domains 7.1e, “Participate in organizational strategic planning,” 7.1f, “Participate in system-wide initiatives that improve care delivery and/or outcomes,” 7.2g, “Analyze relevant internal and external factors that drive health care costs and reimbursement,” and 7.2h, “Design practices that enhance value, access, quality, and cost-effectiveness”  (American Association of Colleges of Nursing, 2021, pp. 44-45).

 The Dallas County Health Promotion program enabled me to achieve Domain 7.1h, “Design policies to impact health equity and structural racism within systems, communities, and populations” (American Association of Colleges of Nursing, 2021, p. 44).

References

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. AACNnursing.   https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf