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Health Science and Nursing Discussion

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Over the years, many health-care organizations have been facing a major challenge in regards to the performance of quality healthcare services of nurses and health care patient’s outcomes. According to Anderson, (2014) is that Affordable Care Act has a great impact on the healthcare systems. Therefore in order to curb this challenge that has perpetuated over the years the ANA joined up to form concepts on how to improve the quality offered by the nurses and the possible outcomes of patients through ranking them, and in the process providing higher salaries on the nurses, (Anderson, A., 2014). Therefore, in this paper, I will examine the pros and cons of the terms related to quality nurse improvement such as Accountable Care Organizations, pay for performance, value-based healthcare, and Medicare star ratings, and discussing the dimensions of quality defining performance on one of the models by also providing four performance standards.

The Pros and Cons of the Models

Part 1

The term Accountable Care Organizations (ACOs) is defined as a group of specialized nurses, health care providers, and hospitals who team up together for giving voluntarily high coordinated quality care to their Medicare patients. This type of concept has its pros and cons such as; it helps give patients with chronic diseases better and quality treatment, there is also less waste disposal in the medical system, patients enjoy a fast physician driven treatment and shared payment risks. The cons of this concept are majorly; there is agreement of providers with an opaque legality, there is difficulty in implementation because they have to share information and capitation.

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Value-based healthcare is a healthcare delivery concept where the service providers, doctors and hospitals and are paid in accordance to outcomes of the patient health. This concept has also its pros and cons which include; it reduces cost in patients, it help reduce medical errors, increases patient’s satisfaction, and promotes healthy habits and behaviours on providers, therefore the nurses are sensitized to provide quality nursing care to patients (Blumenthal at al, 2013). The cons are, it led to less monthly pay in terms of performance and reduce the morale of the provider.

Pay for performance refers to technique used in providing quality of care through undertaking direct the financial incentives to the doctors and health care organizations. Pay for performance has some pros and cons which include; it motivates employees to increase productivity, it reduces medical errors, it ensures proper care of patients and ensures flexibility while the cons are it may led to deteriorating quality performance, it lacks team work, and it provides insufficient motivation.

A Medicare star rating refers to the technique where a nurse is rated according to performance and quality by being given five star ratings. Its pros include; helps keep check the quality offered by the health care providers, motivates providers to improve on quality, help to increase competition to be rated while the cons are it lacks adequate measure to gauge performance and may led to firing of nurses due to low quality performance offered.

Part 2

Aligning payment incentives with quality improvements strategies provides great opportunities to enhance high quality level and excellent services that brings value and dignity for all patients and the US citizens. Pay for performance is one of these incentives that the Healthcare organizations are using to enhance quality services at an affordable prize. Therefore all the medical practitioners have an obligation if they are going to enjoy this incentive or policy then they must show competence and credibility when it comes to performance. For any organization to perform well in the global market and improve on quality delivery they are suppose to apply the use of dimensions of quality defining performance. In regards to that as our health care facility that adapted to Pay for performance healthcare model, we are accessing our performance based of the dimension of quality provided. In this case, I tend to agree that through the use of this model it will provide a long term improvement of performance in the health care centres.

The dimensions of quality defining performance in pay for performance health care model are; Availability, which is used to access the extend to which proper care and services are obtainable and ready for access in by a patient in order to meet the needs of the patient. This is the ease to through which healthcare services can be accessed in regardless of culture, finances, and procedural. Another dimension of quality that defines performance in a pay for performance set up is the appropriateness, (Kans Nurse, 2013), which can be defined to offer accurate in respect to doing the right thing in accordance to the patient’s clinical needs. The appropriateness matters if the providers are going to be paid in terms of quality offered then the care and services given should be relevant according to the current state of knowledge.

Continuity is a dimension of quality that deals with coordination of all services across all involved organizations and a coherent of discontinuity succession of offered services over time. When it comes to performance delivery competency is a key feature which can be termed as a potential of a practitioner’s skills to produce quality health service and satisfactory of the patient and extend to which a practitioner adheres to professional and organizational set standards of providing quality care and practice. Efficacy can be used in performance accessibility. The healthcare’s capability for showing treatment to improve health status is to produce the desired effect or outcome through evidence based scientific research findings. This is called the power of a procedure. Lastly but not the least is providing effectiveness through the current state of knowledge. Providing the correct health to achieve the desired or projected outcome can be administered through effectiveness of the health care provider. Therefore Joint Commission on Accreditation of Healthcare Organization (JCAHO) has an obligation and goals of patient safety to every patient that is been attended in the wards, (Kans Nurse, 2013).

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Part 3

Medical health care system has provided or set some performance standards in order to help them in rewarding of nurses and doctors. There are many examples of that determine standard performance in pay for performance model, (Armstrong University, 2018). These include; Critical thinking ability, for any medical practitioner to be paid through pay for performance he must show the ability to think critically in terms of curing diseases and ability to solve critical cases. This can be evidenced through how he/she creates, evaluates and revises the nursing care plans as appropriate as he can and how he responds critical emergencies. Another performance standard example is the medical care practitioner should show interpersonal skills on how he relates with his juniors/seniors Respect, how he responds to cultural diversity and respects the rights of others. This is what makes the standards of been rewarded in the pay for performance model.

Another performance standard for rewarding performance is communication ability and skills in relation to interpretation of nonverbal cues and behaviours. The nurse is obliged to have the skills on how to communicate with in his journal writings and documentation information of patients record should be well written and appropriately in order to increases chases of been rewarded. Emotional stability; every nurse practitioner must be able to show emotional stability when confronted, also able to provide emotional support of patients and should not pose threat or inflict pain to himself or others.


In conclusion, as the health care administrator, would I propose the adoption of this model for to our organization for it helps improve performance, helps to increase competition and avoid nurses been at laxity completion mode. Through this initiative of pay, for performance will help reduces losses and maximize profits thereof. Many organizations should adopt this initiative in order to improve quality and performance in the business. Through the use of this four model of payments in regards to improvement policy to increase performance, has help many organizations and it has shown great signs therefore every organization should adopt them.

1. Anderson, A. (2014). The impact of the Affordable Care Act on the health care workforce. The Heritage Foundation.

2. Blumenthal, D., & Jena, A. B. (2013). Hospital value‐based purchasing. Journal of hospital medicine, 8(5), 271-277.

3. Kans Nurse, (2013).  Joint Commission on Accreditation of Healthcare Organization (JCAHO) 2003: National Patient Safety Goals.

4. Armstrong University, (2018).  Nursing: Core Performance Standards

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