Nursing shortages result in poor quality of care including – an increase in adverse events – as well as nursing staff burnout. New care-delivery models are needed to retain and attract nurses and provide improved work environments with flexible scheduling, coordinated care and expansion of virtual care.
Before the COVID-19 pandemic, delivery of health care had been extensively analyzed including potential labor shortages. Analysis shows that nursing shortages have a direct impact on patient outcomes and, thereby, the cost of health care. The studies show that reduced nursing/patient ratios result in adverse events such as pressure wounds, falls and hospital-acquired infections.
The pandemic has further exposed the weaknesses of healthcare models, with significant consequences to healthcare workers and patients. The nursing shortages are a result of nurses leaving the profession due to burnout as well as illness. Also, hospitals are delaying or reducing healthcare services because of labor shortages.
In a recent survey, 22 percent of nurses indicated that they may leave their current nursing positions within the next year. There remains a strain on healthcare due to the pandemic pressures and, further, the delivery of healthcare for the delayed services.
Health systems and other employers of nurses recognize this challenge and are actively designing and deploying new care delivery models. A recent survey found that more than 40 percent of frontline nurses have delivered virtual care within the last year, with highest rates reported by nurses practicing in ambulatory and home-care settings. Two-thirds of frontline nurses are interested in providing virtual care in the future. Virtual care has become a more popular option for patients during the pandemic and it also offers a workforce alternative for nurses. It may be particularly appealing for nurses struggling with the physical demands of direct in-person care who are evaluating whether they want to leave the workforce.
Developing strategies and new care delivery models to create more flexibility will be critical. The nursing survey indicated that nurses who experienced more flexibility in scheduling during the pandemic were highly interested in retaining that flexibility going forward. For those nurses who indicated plans to stay in their current direct patient care role, flexibility in hours and shifts was an influential factor.
It is evident that current healthcare delivery models need to change. A shift of where and how care is delivered must be assessed, and new models such as community-based care and integration of virtual visits need to be adopted. These could reduce the pressures and dependency on healthcare delivery in hospitals.
A good evidence-based care model example is the successful delivery of both community-based and virtual care in Israel during the pandemic. The community-based healthcare system reduced the pressures of the pandemic at the hospitals. Citizens and medical staff were infected by the highly contagious Omicron variant; however, the hospitals did not feel the pressures of the pandemic as experienced in other countries.
Israel has one of the strongest community medicine infrastructures in the world. The community-based healthcare providers act as the triage, keeping patients out of hospital while giving them a range of services at home which has kept Israel’s fatality rates modest despite high infection levels.
The healthcare providers or health maintenance organizations (HMOs) have huge networks of clinics, and, in response to the pandemic, also offer telemedicine and online medical service care delivery options. They also utilize sophisticated digital record-keeping to manage vaccine effectiveness.
The HMOs are the frontline in the defense against the threat of the coronavirus. In the community-based model, HMOs try everything possible to have patients fully recovered at home, and they have successfully kept patients out of hospitals during the pandemic. The hospitals play a vital role in the management of those who are in a serious condition, but the majority of Omicron patients are managed by their primary-care physicians in the community. The strong community-based health system is one of the ways Israel is able to spend less of its GDP on health.
Extensive studies on healthcare delivery models such as community-based, clinical-based, and value-based, as well as vertical and horizontal organizational models, show that when applied to healthcare there is a dependency on the various models. Combining different evidence-based care models would increase the effectiveness of strategies meeting patient needs and align with organizational cultures. Physicians should be engaged to become leaders of integrated care teams, which would include nurses and other healthcare professionals, who focus on designing new care delivery model strategies.
In addition, fragmented delivery of care results in high costs and utilization and often poor outcomes, particularly with chronic diseases. Patients with complex care needs receive healthcare through a variety of providers at various sites, including outpatient clinics, primary care practices, specialty clinics, hospitals and others which often don’t have seamless communications. The delivery of care needs to address integration of technology such as virtual visits and telemedicine and include better communication systems across the healthcare providers. This integration will also enable the design of better healthcare models that organize care delivery around the needs of patients across the care continuum.
Lastly, healthcare is rich in data, and this data should guide the design of a new evidence-based care delivery models, especially ones that leverage decision support data that includes clinical, resource utilization and financial data. With new approaches that provide integration, including virtual work models, healthcare organizations will be able to design coordinated and flexible healthcare environments that prevent nursing burnout and future shortages and ideally provide better patient outcomes.
About the Author
Penny Weeks, Vice President, Professional Services
As a senior executive experienced in successfully leading complex operations and long-term projects in multiple sectors, especially healthcare, Penny is a recognized thought leader who fosters client engagement to provide innovation and advancement of healthcare information management throughout the healthcare system. She has also provided strategic direction and leadership for the development and implementation of Ontario’s provincial case costing initiative. Penny earned her MBA from the University of Toronto.
