Collaborative practice is among the most-mentioned topics when considering quality improvement in health care. The most common terms mentioned when dealing with collaborative practice include teamwork and collaboration. However, a group of researchers endeavors to bring to the fore a different concept called co-management. The researchers hold various designations in the health care field; thus their findings offer a close semblance to actual situations in clinics. Allison Norful and Lusine Poghosyan are resident nurses, Jacq Krystyna is an MSN; while Richard Carlino is an MD (Norful, de Jacq, Carlino, & Poghosyan, 2018). The researchers try to determine the best way patient care could be improved by nurse practitioner-physician co-management. In this regard, the study combines findings from previous research and 126 interview feedbacks from nurse practitioners and physicians.
Description of Article
Purpose
This study aimed to present an appropriate model of how nurse practitioner-physician co-management can improve patient outcomes. The motivation for carrying out the research was the fact that the nurse practitioners and the physician were the two central professionals that were concerned with the primary care of the patient ( Lancaster, Kolakowsky ‐ Hayner, Kovacich, & Greer ‐ Williams, 2015). However, these two experts work increasingly independently. The situation is absurd given that the number of people seeking health care services is on the rise every day. Teamwork and collaboration reduce the workload significantly. Therefore, finding an appropriate form of rolling out collaboration between various professionals will be a big plus in the achievement of quality healthcare in many healthcare facilities.
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Results
The outcomes of the study, after conducting 126 interviews and consulting secondary sources in the field , indicated that three main aspects needed to be included in the co-management (Norful et al., 2018). First, effective communication is necessary to enable smooth operations. Therefore, there will be a need to reconsider the organizational structure to ease the flow of information (Lancaster et al., 2015). Secondly, there ought to be mutual trust between the various experts especially the nurse practitioners and the physicians. Undermining one party will be detrimental to teamwork. Lastly, the facility should align the philosophy of care so that both parties share the same vision. Summarily, the results reveal the need to break all the previous barriers that existed between nurse practitioners and physicians.
The researchers note that organizations that wish to implement this model will have to contend with legal and organizational impediments. The situation arises since there are inhibitions for nurse practitioners to carry out their mandate having the same kind of management resources as primary care physicians (Norful et al., 2018). Streamlining these barriers will require active intervention by the hospital board which will have to treat the two groups of experts as being on the same level. If not, there ought to be an improvement in resource allocation to the nurse practitioners and maintain the resources for physicians.
Clinical Application
The application of the nurse practitioner-physician co-management is straightforward. The two professionals jointly attend to a single patient until he or she is well and ready for discharge. Such a model ensures that the professionals carry out timely deliberations regarding the state of the patient and come up with joint suggestions on the best way forward (Cohen et al., 2015). Areas the two professionals will collaboratively handle are pharmacologic management, patient education, risk reduction, patient follow-up, diagnostic testing and medication refills (Norful et al., 2015). Such collaboration ensures that the patient is attended to wholesomely. The process reduces the time a patient stays at the hospital and also the number of readmissions. Such elements are crucial for the improvement of quality in healthcare.
Effects of the Presentation on Clinical Staff
The presentation was received well at the facility as it had clear elaborations. The definition of co-management was straightforward as it means two experts are working on a single patient. Further, the presentation outlined in definite terms the activities that each of the nurse practitioner and the physician would be handling (Norful et al., 2018). Also, the necessary changes that would be needed in their organizations to ensure the co-management rolls outs smoothly were well elaborated. In this regard, it was easy to bring most people on board regarding adopting such a system in the clinic.
There are various terms used in the field of collaborative practice that was of interest to the group at the clinic. Most of them were surprised to realize that the definition of the terms in the health care field could help in re-aligning activities and changing the organizational culture (Hamel & Vossing, 2017). The three main terms used include teamwork , collaboration, and co-management. The three words were disambiguated clearly in the article as well as in the presentation. When it comes to teamwork, a group of experts in the healthcare fieldwork jointly in attaining a specific objective . When it comes to collaboration, two experts will deliberate on an issue and share knowledge to find the best way forward. However, co-management entails experts from different fields working collaboratively on one patient to achieve positive outcomes (Norful et al., 2018). Therefore, the main difference between collaboration and co-management is the fact that in the latter, experts from different fields of specialization work together by having mutual trust, respect, and shared vision.
The presentation on co-management also opened avenues for the staff to give their opinions about how it could be applied throughout the organization. The clinic employees noted that co-management entailed completing paperwork, care coordination, providing the patient feedback and sharing administrative workload (Norful et al., 2018). Such aspects would go a long way to make work easy in various departments that the workers felt that co-management could lead to a total organizational culture overhaul. The collaboration between family nurse practitioners and medical doctors offered the promise of working in the same manner as the nurse practitioner-physician bond. Therefore, it was thrilling that the idea of co-management was opening avenues for other possibilities of quality care improvement.
Clinical Application
The contents of the article apply directly to clinical situations with the hope of offering positive patient outcomes. The co-management models between the nurse practitioners and physicians will reduce the congestion experienced in many health care facilities. Many hospitals currently receive a higher number of patients than they did in previous years (Hamel & Vossing, 2017). Further, most of the patients come with multiple conditions. Such a situation requires team-like efforts to help address the comorbidities in totality. In such cases, it is only practical that the professionals attending to patients follow through all the stages of the treatment process as a unit. Therefore, co-management between nurse practitioners and the physicians will ensure that medical mistakes are reduced and that the patient has fewer admission days as well as readmissions.
The model will be adopted smoothly in many health care facilities as one of its outcomes involves reducing workload. Co-management entails having more than one primary caregiver attending to a patient (Norful et al., 2018). The shift from the current system where one person makes decisions will ensure that the work on one patient is equally distributed among various experts. The sharing of knowledge and deliberations on a patient ensures that patients receive timely attention. Medical mistakes will be reduced to a great extent which will reduce tension among workers in the hospital. The implementation of the model will work in favor of most employees on the facility, thus, will not receive much resistance from various quarters of the hospital.
The influence of the co-management model on the organizational structure cannot be overlooked . In most cases, the teamwork and collaborative approaches work well with the vertical organizational structure (Cohen et al., 2015). In this manner, the employees work under the instruction of the professional above them. Such a system leads to a situation where employees on the lower cadre of management may feel intimidated to deliver results.
On the contrary, co-management requires a horizontal organizational structure. This system needs different experts to work with their teams but overlaps horizontally, putting into consideration the urgency or complexity of a particular care seeker (Norful et al., 2018). Such fluidity in operations will ensure that the efforts of the workers are geared towards attaining the best outcomes of every patient. In the process, it will create an aura of creativity, honesty, curiosity, and humility which are relevant in the process of instilling a culture of excellence (Lancaster et al., 2015). The process is unlikely to lead overlapping of roles of confusion in the offering of service as each employee will be working within their department and only shift to a different section on the instruction of their representative. It is the leaders in the various units that will be involved in the co-management.
The nature of primary care practice is crucial to patient outcomes. When the system favors the disparate approach to service delivery, there are bound to be cases of errors, delays, and confrontations among various teams. However, with the co-management strategy, there is likely to be respect and mutual trust among groups since they will share the same clinical philosophy. The co-management of nurse practitioners and the physicians go a long way to ensure that the patient health is handled holistically thus should be embraced by all healthcare facilities.
References
Cohen, D. J., Davis, M., Balasubramanian, B. A., Gunn, R., Hall, J., Peek, C. J., & Pollack, D. (2015). Integrating behavioral health and primary care: consulting, coordinating and collaborating among professionals. The Journal of the American Board of Family Medicine , 28 (1), 21-31.
Hämel, K., & Vössing, C. (2017). The collaboration of general practitioners and nurses in primary care: a comparative analysis of concepts and practices in Slovenia and Spain. Primary health care research & development , 18 (5), 492-506.
Lancaster, G., Kolakowsky ‐ Hayner, S., Kovacich, J., & Greer ‐ Williams, N. (2015). Interdisciplinary communication and collaboration among physicians, nurses, and unlicensed assistive personnel. Journal of Nursing Scholarship , 47 (3), 275-284.
Norful, A. A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner–physician comanagement: a theoretical model to alleviate primary care strain. The Annals of Family Medicine , 16 (3), 250-256.
