Abstract

Healthcare is essential to everyone and must be considered as a human right available to everybody. Despite being essential, it is one of the most expensive needs of Americans and other citizens. A patient care system provides health care services that meet needs of individuals. To improve patient-centered care, the entire U.S. healthcare system is undergoing a dramatic change. The change is also driven by the need to deliver health services in cost-effective ways. Healthcare professionals are the key pillars of the patient care delivery system. Therefore, it is vital to identify and understand the transformation taking place within the healthcare systems, as well as the role played by healthcare profession. In other words, when discussing challenges faced with patient care, there is a need to highlight challenges faced by the system, as well as challenges faced by healthcare professionals. This paper highlights the challenges faced with patient care from various perspectives and then discusses the impacts of the challenges alongside with their remedies.

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Challenges Faced with Patient Care

Patient care entails services rendered by health professionals for the purpose of restoring, promoting, monitoring, and maintaining health of a patient. Broadly speaking, patient care involves prevention, treatment, and management of diseases, as well as preservation of the physical and mental well-being through services delivered by medical and related health professionals. Improving patient care is increasingly becoming one of the priority areas for health care providers with the aim of improving patient satisfaction. This change is propelled by factors such as medical malpractice, healthcare regulation, technological advancements, competition, demand for better care, and increased public awareness. Millions of American citizens receive quality patient care services because the U.S. has one of the world’s greatest research institutions, healthcare facilities, as well as medical and allied health professionals. However, the quality of patient care provided is often substandard. Frequently, patients receive services that undermine the quality of patient care and needlessly increase costs. In some scenarios, patients do not receive healthcare services that have been demonstrated to be effective at reducing costs and improving health outcomes. For example, the Centers for Disease Control and Prevention (CDC) highlighted that 5% of inpatients tend to develop a  health-associated infection (HAI). HAIs are not only prevalent, but also costly and ranging in the tens of thousands of dollars (CDC, 2009). The quality of patient care is essentially determined by the quality of training, quality of infrastructure, efficiency of operational systems, and competence of the personnel. Similarly, the delivery of patient care depends on the same factors. Effective patient care delivery requires clinical knowledge and practices that identify and address new issues facing the delivery of service. In other words, proficient patient care requires understanding of issues that foster physical therapy practice and influence the delivery of care. This paper discusses some challenges facing patient care in the United States.

Literature Review: Challenges Faced With Patient Care

Patient care is largely delivered by nurses (Nursing and Midwifery Council (NMC), 2008). When providing patient care, health professionals are expected to deliver quality service to the standards of practice. In the same line, healthcare professionals must follow the professional code of ethics (NMC, 2008). Further, they must follow the code to ensure that they use the right principles to optimize healthcare. It is also the responsibility of the healthcare professionals to assess patients. Assessment entails collecting all-inclusive information relevant to the patient’s situation or health. Healthcare professionals are also responsible for implementing care after the assessment of a patient (Ammenwerth, Schnell-Inderst, Machan, & Siebert, 2008). Furthermore, they ensure that the recommended plan of patient care is completed. It follows that most of the challenges faced with patient care are directly linked to the challenges faced by professional nurses and other healthcare professionals. Having done an overview of the role of health professionals in the delivery of patient care, the section that follows explores some of the challenge faced by healthcare professionals and other stakeholders while delivering patient care. In a recent study conducted by Kamra, Singh, and De (2015) to establish factors that affect patient satisfaction and their link to the demographics of patients, the authors have found that several factors influence the patient outcome and the resultant patient satisfaction. Some of the factors highlighted include staff and nursing care, behavior of doctors, professionalism of doctors, convenience and affordability of the patient care, fulfillment of clinical requirements, administrative procedures, amenities and infrastructure, and facilities at the out-patient department or the reception area (Rosseter, 2014).

The study has also revealed that there was a variation in patient care and satisfaction along demographical lines such as education, occupation, and residence (Kamra et al., 2015). Given that patient care is directly linked to patient satisfaction, it would also be logical to highlight challenges faced with patient care from the perspective of patient satisfaction. From this study, it is quite clear that inequalities in healthcare affect patient care and ultimate patient satisfaction (Swayne, Duncan, & Ginter, 2012). Ideally, all patients should receive similar patient care services for similar cases. In that respect, there would be no variations in patient care delivery. To have a clear understanding of the challenges faced with patient care, the following section reviews different challenges from various perspectives. The ever-increasing sophistication in disease diagnosis and treatment of the medical condition contributes to the escalation of patient care cost (American College of Healthcare Executives (CHE), 2014). In the same line, there is a proliferation of costly drugs for patients, especially those with chronic conditions. Besides diagnosis, treatments, and medication, the growing aging population also contributes to the surging cost of patient care (Swayne e al., 2012).

Other factors that further increase the high cost of patient care include technological advancements and the increasing number of people with chronic illnesses. According to an annual survey by the American College of Healthcare Executives (ACHE), financial challenges are ranked as one of the most challenging issues faced by hospitals, thereby affecting the delivery of patient care (ACHE, 2014). As noted by the ACHE (2014), taking care of patients and improving their safety, as well as the quality of patient care are considered to be the highest priority in the hospital. In the same line, healthcare leaders and managers acknowledge that these priorities must be addressed in the current environment of government mandates, dwindling reimbursement, and complex payment reform (Swayne et al., 2012). Health care in the United States is very expensive, meaning that most people do not have adequate access to healthcare. In most states, the poorest adults without children do not get Medicaid. Affordable Care Act (ACA) was meant to fix this problem, but that has not been the case in most states because the Supreme Court’s decision made Medicaid expansion optional. In that respect, some states have not adopted the program fully. Besides, parents in some states have to be extremely poor to be eligible for Medicaid. As noted by Allen and Carr (2009), the costs of acquiring and implementing digitized healthcare systems are significant, especially for medical practitioners and health facilities. The other financial challenge attached to the implementation of technologies that improve patient care is training and maintenance costs attached to the systems. The misaligned cost burden for adopting patient-centered systems is also an impediment to the delivery of quality patient care (Sydnor & Perl, 2011).

For instance, for an effective EHR system to be functional and interoperable across the country, there must be an active clinical information systems in place (Swayne et al., 2012). This translates to a financial burden to the government and implementers in the private sector. Challenges such as hospital acquired infection (HAIs) also increase the cost of healthcare to insurance companies and the individual covering avoidable extra medical bills incurred when patients are readmitted or overstay in hospitals (Sydnor & Perl, 2011). To that line, the quality of health is affected because the pressure is induced on the infrastructure, facilities, and the healthcare personnel. Furthering the impact of hospital overstays and readmissions, the lack of access to health services has a detrimental impact on the functioning of the entire healthcare system (Ammenwerth et al., 2008). In this context, access is not limited to geographical or physical location of health facilities, but is expanded to cover finance, knowledge, and time resources because they impact the behavior of both patients and patient care service providers (Sydnor & Perl, 2011). Observably, financial challenges and accessibility issues have a significant impact on the health of an individual and the well-being of the society. Effective interventions to improve the quality of primary care are well known. However, progress is slow because of poor access and the high cost of healthcare services (World Health Organization (WHO), 2009).

Improving the quality of primary health services is a key programmatic challenge in the United States due to resource constraints. Political commitment or will to address primary health issues in the U.S. is inadequate. Although the government has developed several policies and it is committed to improving primary health, there is a gap between formulated policies and their implementation. Additionally, there is a lack of coordination between health staff and policy makers (Swayne et al., 2012). Ineffective management of health systems hampers the quality of service and renders the existing referral system as ineffective. The United States also lacks an enabling policy setting with supportive laws and health management reforms, which are vital in addressing supply barriers to core lifesaving services (Swayne et al., 2012). Political commitment in executive government branches and the health sector must be improved to increase the allocation of resources to reach rural settings, provide finances to address inequalities, and provide safety nets to poor taxpayers. The widespread application of evidence-based medicine has been proven to help healthcare professionals facilitate their utilization of healthcare technologies to improve patient outcome (Allen & Carr, 2009). However, there are numerous challenges to the deployment and adoption of electronic health record (EHR). Central to this review is the fact that there is cultural resistance to Evidence-Based Medicine from various entities that are yet to validate the facts about the EBM (Allen & Carr, 2009). Almost a decade ago, a report by the Institute of Medicine (IOM) Committee on the quality of Healthcare in the United State found that approximately 44,000 to 90,000 American patients could die annually due to medical errors (Allen & Carr, 2009).

Since the release of this report, the U.S. healthcare sector has continued to suffer from the distinction of delivering less optimal patient care service and patient outcomes at a high cost. Medical errors highlighted in the report were largely linked to human error. According to the Federal Drugs Administration (FDA), medication errors are preventable events that cause or lead to an inappropriate use of medication or patient harm (FDA, 2015). These errors are noted when the medication is under control of either the patient or the health professional. In line with the Institute of Medicine (IOM) report, other factors linked to medical errors include poor nomenclature, prescribing, packaging, and labeling. A review of the impact of using the digitized system for prescribing, administering, and monitoring medication processes has indicated that there is a 99% reduction in medications errors (Ammenwerth et al., 2008). Despite the continued demonstration of the effectiveness of the digitized system (Radley, Wasserman, Olsho, Shoemaker, Spranca, & Bradshaw, 2013), there is a considerable resistance to digital transformation (Allen & Carr, 2009). The cultural resistance is regarding concerns about patient safety and privacy issues. Patient heath care-related equity can be explored from two dimensions: equity in patient health financing and equity in service delivery. Inequities exist in the United States because there are disparities in health financing and delivery of health services (Sydnor & Perl, 2011). Inequities in the U.S. are marked by disparities in socio-economic groups as characterized by aspects such as occupation, gender, wealth/income, geographic location, education, and race/ethnicity. Scientific evidence points out that the availability of good healthcare is inversely related to its demand in developed countries like the USA. For this reason, the achievement of equal and fair access to healthcare is likely to be compromised if the prevalence of variations to the access of health is not addressed properly (Radley et al., 2013). Evidently, poor Americans are at a higher risk of inaccessibility to basic health service. In the same line, these poor people meet various barriers to utilization of health services. Due to poor structures and management of patient care among the uninsured or the underinsured, this population segment has limited access to health information and services. Underserved groups such as the homeless, the uninsured, and the underinsured are likely to have unmet needs (Sydnor & Perl, 2011).

For this reason, the U.S. government should target the most vulnerable groups by improving access to information and utilization of primary health services. The extent to which patient care for American citizens is efficient, timely, and appropriate for a specific individual depends on the characteristics of the healthcare service delivery system. Kamra et al. (2015) have considered some structural barriers, process inefficiencies, and systems failures that are serious impediments to the delivery of quality patient care and limit the delivery of highly efficient, effective, and evidence-based patient care. The patient care culture is focused on individual health professionals because it influences the way they behave (Porter & Teisberg, 2006). Their behaviors depict the way they are educated, hired, as well as their reliance on the demanding healthcare environment. If change is to be realized in patient care, these roots must be addressed. Observably, the culture of health providers in the United States is marked by clashes between competing forces (Radley et al., 2013). That is to say, stakeholders oppose each other to obtain competitive advantages instead of collaborating to improve the delivery of patient care. For the United States to achieve an improvement in the delivery of patient care, competitive clashes should be transformed to positive competition in which stakeholders combine resources to achieve patient-centered results (Rosseter, 2014). The continuous and disruptive change in the U.S. health sector limits efforts of health professionals to scale up their data handling efforts (Sydnor & Perl, 2011).

The enormous data from discoveries in areas such as genetics, proteomics, and genomics should be archived and analyzed to mine the intelligence in the data. According to Porter and Teisberg (2006), stakeholders in the U.S. healthcare industry compete in a zero-sum playfield. The U.S. healthcare system is marked by clashes among competing forces. For instance, health professionals focus on their autonomy and remunerations. In turn, care facilities focus on profitability and reduction of costs. Further, suppliers force on volume and intellectual property protection. Simultaneously, patients focus on affordable and accessible services. Insurance companies seek the right to select the cost and limit of a risk. These clashes raise some cultural barriers to high-quality patient care. Besides, incentives are not aligned (Norris, 2007). Healthcare providers are often paid more for overuse of resources. Moreover, providers are paid more for an episodic task and little for coordinative and cognitive work (Sydnor & Perl, 2011). Healthcare leaders also have limited authority because of the autonomy of physicians and high completion among health facilities for physicians. The distrust among stakeholders also contributes to poor quality of patient care. The federal and state governments are devoted to improving health and healthcare of all American citizens irrespective of their race, age, genders, and income levels (HRSA, 2011).

Central to this commitment is transforming the way healthcare is delivered in hospitals to reduce the shortage of nurses in public healthcare institutions and to advance the quality of patient or nursing care (Rosseter, 2014). Registered nurses educate the public and patients about health conditions, coordinate patient care, and provide emotional support to patients and the society (U. S. Bureau of Labor Statistics, 2014). They work in nursing care facilities, hospitals, military, and correctional facilities. Visibly, nurses form one of the key pillars in the provision of high-quality patient care. To attract and retain highly-qualified nurses, adjustments must be made in the use of Information Technology and organization of work, hospital culture and leadership approaches, and physical design (Swayne et al., 2012). Working alongside with other stakeholders, healthcare policy makers should garner support for improved public health care facilities that mirror the reality and needs of the current world. That is, hospitals where efficiencies are optimized, patients’ safety is assured and the staff are motivated and actively supported in their profession. In response to the ever-growing demand for high-quality patient care as a result of healthcare reforms and the growth of the population of the aging people, healthcare professionals are needed more than ever (U. S. Bureau of Labor Statistics, 2014).

The contemporary healthcare system faces numerous problems, motivating the nursing fraternity to engage in the formulation of regulations and policies that transform the healthcare system. The United States is projected to continue confronting the cyclic shortage of registered nurses as the demand for healthcare grows (Rosseter, 2014). The problem is complicated because nursing schools also struggle to deliver nurses in synchrony with the rising demand for quality care because of the national healthcare reforms, particularly the Obamacare Act. Nurses form the largest segment of healthcare professionals providing patient care in healthcare facilities. In the same respect, the quality of patient care is closely related to the performance of the nursing workforce (Swayne et al., 2012). The supply of nurses never balances the industry demand. For this reason, there are never enough nursing personnel to meet the current demand. The need to cover the cyclic shortage of healthcare professionals implies that there are numerous opportunities for healthcare professions (Rosseter, 2014).

Impact on Health

The secondary goal of this paper is to explore the impact of the challenges faced with patient care on health. Given that health is a universal issue, this section will also explore the impact of these challenges on individuals, families, and communities. The literature on patient care financing is either business-oriented, emphasizing financial systems within the healthcare industry, or the line that emphasizes financing of service delivery (Allen & Carr, 2009). With the U.S. spending more on patient care than any other country, there is a growing notion that the high health care costs have a negative impact on the quality of care. In the same line, there is an argument that high cost of healthcare in the U.S. induces variations in patient services and patient outcomes (Norris, 2007). The United States’ healthcare cost per capita is among the highest globally. Furthermore, the review above has indicated that significant aspects of the U.S. healthcare are ineffective or redundant. Additionally, a major cost of the U.S. healthcare is channeled toward administrative processing. The other challenge that faces the U.S. patient care delivery outcomes is the growing aging population and the population of uninsured individuals. A major challenge of information technology as a cost-saving initiative in patient care is resistance to change from providers (Sydnor & Perl, 2011).

Patient care providers cannot exercise their functions outside of FDA-approved drugs and Standard Operating Procedures (SOP) because failure amounts to malpractice (Allen & Carr, 2009). Where multiple alternatives for treatment are available, regional and local health professionals’ cultural norms tend to influence variations in some aspects of the medical protocol delivered such as imaging exams performed and ordered lab tests. In other words, patient care service providers must rely on limited information and clinical trials even though there are evidence-based medications or options available in electronic forms (Sydnor & Perl, 2011). Furthermore, conventional systems limit speed and accuracy in which standards can be improved. As of consequence, resistance by providers affects the quality healthcare. As the U.S. government strives to mitigate health inequalities, the United States’ public sector is inclined to support provision of subsidized or free services to both middle-income and lower-income classes of citizens (Rosseter, 2014). Unfortunately, the United States’ private sector lacks tangible incentives to reach women in lower-income groups. Luckily, NGOs and donor communities have a comparative advantage of the private health sector in mobilizing and reaching poor groups. However, the nongovernmental sector is limited regarding human resources, geographical coverage, and technical skills. Lack of technical expertise occurs due to the fact that while the NGOs make progress in improving primary health and reducing Hospital Acquired Infections (HAIs) on a national level, there are hidden discrepancies across various income groups (Allen & Carr, 2009).

The growing trend in health inequities, especially in the delivery of basic healthcare is likely to jeopardize the effort of the United States’ government relating to its healthcare goal of equitable and fair access to affordable healthcare (Allen & Carr, 2009). To counteract the inequities, the U.S. government should increase the coverage of primary health services in deprived population groups through effective delivery strategies and appropriate targeting mechanisms. Improving the quality of service entails training the staff, developing technical capacity and expertise, providing adequate supplies and equipment, providing continuous supervision, and establishing accreditation process and quality of standards. The U.S. government acknowledges that improving the quality of primary, secondary, and tertiary health services goes beyond improving standards and technical competence (Rosseter, 2014). In that respect, the government should provide information, education, and counseling, improve provider-client interactions, and provide a variety of services to the underinsured or the uninsured. Further, the government should provide finances to various public health institutions to improve access and use of services, improve technical quality, ensure client satisfaction, and improve referral to emergency care (Norris, 2007). By refining information and monitoring systems linked to logistics and health, the U.S. government progresses primary health by improving management. One of the challenges facing U.S. patient care quality is staff shortages and poor distribution of skilled care providers. The burnout among healthcare professionals in the U.S. has a negative impact on the services delivered and the government's efforts to address variation in quality and patient outcome (Radley et al., 2013).

In addressing these challenges, the U.S government should continue to fund the use of medical care and skilled attendance staff shortage is a result of several factors, including economic constraints, limited training capacity of nursing and medical schools, and emigration of professionals to the private sector, urban areas, and developed countries (Radley et al., 2013). For this reason, the U.S government should strive to harmonize remuneration of health professionals to attract talented individuals and retain them in the public sector. The government should also improve staff incentives and remuneration in training and promotion. Further, the government should develop staff rotation and deployment policies to improve management of the health sector. Government and private partnerships are critical and central to addressing challenges facing patient healthcare. The federal and state governments should continuously strengthen its partnership with donors and private health sector. Community-based organizations and NGOs can be brought onboard as legitimate partners, thereby improving the delivery of healthcare services (Radley et al., 2013). Through partnerships, the U.S. government can tap the potential of the private sector regarding accreditation, regulation, contracting, skills development, and inclusion of private health facilities in the referral system (Sydnor & Perl, 2011). To address the issue of inter-hospital competition for physicians, the government should improve career development, upgrade training, harmonize public and private sector pay grades, and acknowledge hardworking professionals.

Conclusion

This study has cemented the knowledge base around the challenges faced with patient care in the United State. From the literature review and the discussion above, it is apparent that patient care faces numerous challenges, including administrative, financial, ethical, and technologically-oriented challenges. The delayed implementation of digital medical systems not only increases pain and suffering of patients, but also undermines the time and resources invested by healthcare professionals in researching evidence-based medicine. Following the highlighted benefits of implementing information technology (IT) in the patient care, government agencies should facilitate adoption of evidence-based medicine and technologies by partnering with the healthcare industry’s stakeholders to develop a standard for health and medical records, covering terminology, content, and interoperability. Additionally, responsible health-based government agencies should identify costly and demanding clinical treatment areas and then prioritize technology in those areas to reduce demographic variations in the cost of patient care and outcomes. Regarding financial challenges, the US government should develop and implement financial incentives designed to reduce the financial burden facing taxpayers. In the same line, the government should also fund collection and archival of comprehensive patient information. {t_essay_1}

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