. "F Health Care System Reform and the Nursing Workforce: Matching Nursing Practice and Skills to Future Needs, Not Past Demands." The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press, 2011.
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The Future of Nursing: Leading Change, Advancing Health
ies assessing supply and demand for various health care clinicians and factors contributing to recruitment and retention of health care workers—with little time spent on assessing the optimal mix of clinicians and skills to achieve cost and quality outcomes. By failing to integrate these two analytic areas, we produce a health care workforce that is poorly positioned to efficiently and effectively enact delivery system reforms that stand to improve system performance and costs. Demonstration projects that assess the effects of service delivery innovations and encourage a range of skill mix models as well as role differentiation (i.e., who performs which tasks) will grow the evidence base that is sorely needed to inform both health system redesign and workforce planning. Only a concerted and cumulative effort will produce the evidence needed to guide payment policy changes that support delivery system and workforce reforms.
The U.S. Department of Health and Human Services should establish a government-wide interagency innovations research collaborative comprising all agencies/departments engaged in health care service delivery and research, with the goal of testing new models to organize and pay for health care services and determining the workforce features critical to achieving desired cost and quality outcomes from these new models. The Quality Interagency Coordination Task Force (QuIC), established in 1998 harness the federal government’s efforts in health care quality improvement, offers a prototype for such an initiative (AHRQ, 2001). The purpose of the QuIC was “to ensure that all Federal agencies involved in purchasing, providing, studying, or regulating health care services worked in a coordinated manner toward the common goal of improving quality care.” Our proposed innovations research collaborative would span such agencies as the Veterans Health Administration, the Department of Defense, the Agency for Healthcare Research and Quality, the National Institutes of Health, and CMS. The new Center for Medicare and Medicaid Innovation established under health reform would be an integral participant. Dedicated funding from each agency would be set aside to build the pool of funds available to undertake the concerted body of research needed and increase the target populations and workforce configurations studied to further our understanding of how to most effectively structure these innovations. Private-sector partnerships would be encouraged, especially with the payer community, since an appropriately aligned payment policy is the linchpin to adopting new models of care by providers and demanding the workforce needed to enact them. Additional partnerships with organizations engaged in quality and outcomes measurement, such as the National Quality Forum, should likewise be pursued. An independent advisory board should be empanelled to develop recommendations on the innovations research agenda to be pursued by the collaborative.
In addition to determining the skill mix configuration that produces optimal cost and quality outcomes, a full assessment of the methods and processes by which those configurations are achieved will be needed. This assessment would explicate the range of policy and strategic initiatives that could be pursued to