title: Value-added care: a paradigm shift in patient care delivery.
abstract: Spiraling costs in health care have placed hospitals in a constant state of transition. As a result, nursing practice is now influenced by numerous factors and has remained in a continuous state of flux. Multiple changes within the last 2 decades in nurse/patient ratio and blend of front-line nurses are examples of this transition. To reframe the nursing practice into an economic equation that captures the cost, quality, and service, a paradigm shift in thinking is needed in order to assess work redesign. Nursing productivity must be evaluated in terms of value-added care, a vision that goes beyond direct care activities and includes team collaboration, physician rounding, increased RN-to-aide communication, and patient centeredness; all of which are crucial to the nurse's role and the patient's well-being. The science of appropriating staffing depends on assessment and implementation of systematic changes best illustrated through a "systems theory" framework. A throughput transformation is required to create process changes with input elements (number of front-line nurses) in order to increase time spent in value-added care and to decrease waste activities with an improvement in efficiency, quality, and service. The purpose of this pilot study was two-fold: (a) to gain an understanding of how much time RNs spent in value-added care, and (b) whether increasing the combined level of RNs and unlicensed assistive personnel increased the amount of time spent in value-added care compared to time spent in necessary tasks and waste.
authors.affiliation: UCLA School of Nursing, Nursing Administration Graduate Program, Los Angeles, CA, USA.
authors.forename: Valda V
authors.initials: VV
authors.lastname: Upenieks
authors.forename: Jaleh
authors.initials: J
authors.lastname: Akhavan
authors.forename: Jenny
authors.initials: J
authors.lastname: Kotlerman
mesh_terms: D002140:California; D003363:Cost Control; D004526:Efficiency; D006801:Humans; D017146:Models, Organizational; D009728:Nursing Assistants; D009732:Nursing Care / Q000592:standards; D009741:Nursing Staff, Hospital / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D010561:Personnel Staffing and Scheduling; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration; D013647:Task Performance and Analysis