In healthcare, stakeholders have varying perspectives when it comes to quality and value of the services offered by the numerous healthcare institutions. The different views of the people with a stake in the healthcare industry make quality improvement and value addition a controversial and complex topic. The potential areas of conflict exist between the patient and the employer and the providers and the payers (Shaw & Elliot, 2012). These stakeholders have different views and perception of the care delivery system. And there may exist numerous potential areas of conflict. Some of the major stakeholders in the healthcare include the providers, the payers, the employers and the patients.
Regarding quality, the providers view the healthcare delivery process as a technical one. To them, quality is an accurate diagnosis, positive outcome and appropriateness of the strategy used. Employers, on the other hand, want to manage their costs and human resource. They want their employees back to work quickly and in healthy condition. Payers also focus on the cost effectiveness of the services offered by the providers. Patients want a positive outcome, compassion as well as skillful service delivery and clear communication by the nurses and physicians.
Value and Quality
Quality and value are correlated, and the perspectives may overlap depending on the stakeholder. Patient believe that more and newer treatments are better and mean that they will get values for their money. Physicians and nurses have different dimensions when it comes to their views on value. They believe that when costs are made distinct from an assessment of quality, those involved in cost reductions are primarily motivated by the dollar saving and not patient outcome. The dollar savings also do not accrue to either the patient or the providers resulting in the perception that the cost-saving programs are untrustworthy. Payers do not have significantly different from the other stakeholders, but they have a role to play in improving the value of the healthcare by making their coverage decision based on clinical and research evidence. Most of the business models run by the payers are focused on obtaining profit and not predicated on getting the value (Yong, Olsen & McGinnis, 2010).
The potential conflict between the patient and the employer exist from the fact that the patient wants the employer to make available a wide variety of options for healthcare coverage. They want the options to be customized according to their specific needs. Employers, on the other hand, want to keep their costs to the lowest level possible hence it is unlikely that the employer will provide a broad range of options for the employees. On the other end, the employee wants the employer to fund the majority of the coverage, provide more options and the least out-of-pocket cost for the worker.
Providers and payers have opposing views when it comes to quality issues. Payers include the health plan sponsors, insurance carriers as well as other third party entities. Payers want providers to follow an evidence-based approach when coming up with a diagnostic and treatment plan. Payers believe that evidence-based approach will help the nurses and physicians reach an accurate diagnosis and treatment plan which will limit the number of tests and visits to the hospitals (Shaw & Elliot, 2012). Providers may want to provide preventive care that the insurance companies may not be willing to cover. Caregivers tend to use the newest and latest technologies that are most likely expensive but believe will deliver accurate diagnosis and treatment.
Effect on Service Delivery
The conflicting perspective among the stakeholders surely has ripple effects in the whole industry. First, the cost-effectiveness approach of the providers and payers means that they are more focused on cutting expenditure and other health associated costs. This focus on value means that the more research and evidence-based practice will be sort after that helps improve the overall effectiveness of the healthcare system. Improved quality of the services means that patients make less visits back to the care providers. Employers now engage in preventive strategies where they reward employees based on their participation in the wellness programs. Such incentives will encourage employees to exercise more and lose weight hence get rid of weight-related health problems. With the rate of visits to the hospitals on the decline and more and more individuals engaged in wellness and fitness programs then the overall efficiency of healthcare delivery system will be on the rise while at the same time save money for all the stakeholders.
I believe that the competing perspectives of the different professional works for the benefit of improving the quality of services in the industry. Every individual whose interest are not met will seek all legal procedures to ensure that they are met and such improve the efficiency and effectiveness of the healthcare sector.
Conclusion
In order for the industry to operate with efficiency then the needs of all the individuals with an interest need to be taken into consideration. In order for the care delivery process to be a smooth one then evaluations need to be conducted to encompass all the views, needs and expectations of all the stakeholders. The first step is to make it explicit what the patients, the employers, and the insurance companies regard as an essential mission of the health care (Shaw & Elliot, 2012). The central focus of the different stakeholders must define ways with which quality can be measured as well as the value expectations from the providers. Areas where objectives are not shared but do not necessarily mean conflict of interest, then these areas can be included in the quality and value measurement system.
Nurse and physicians need also to understand and avoid the potential conflict of interest in order for them to maintain professional integrity. A conflict of interest by the professional has far-reaching effects and nursing leaders need to take and encourage others to undertake training that addresses conflict of interest. Nurses and physicians are just as easily influenced by the marketing practices just like any other professional in other industries. The professional need also to seek ways they can collaborate with the service marketers and payers on how their actions might have an impact on patient care decisions. Professional can also get involved with the development of healthcare policies that address the professional industry relationship.
References
Shaw, P. & Elliot, C. (2012). Quality and Performance Improvement in Healthcare. Chicago: AHIMA.
Yong, P., Olsen, L. & McGinnis, J. (2010). Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation. Retrieved 17th February 2016 from http://www.ncbi.nlm.nih.gov/books/NBK50926/
