Prepare: Review The National Healthcare Issue Or Stressor ✓ Solved

Prepare: Review the national healthcare issue/stressor you e

Prepare: Review the national healthcare issue/stressor you examined in your Module 1 Assignment, and review the analysis of the healthcare issue/stressor you selected. Identify and review two evidence-based scholarly resources that focus on proposed policies/practices to apply to your selected healthcare issue/stressor. Reflect on the feedback you received from your colleagues on your Discussion post regarding competing needs. Add a section to the paper you submitted in Module 1. The new section should address: Identify and describe at least two competing needs impacting your selected healthcare issue/stressor. Describe a relevant policy or practice in your organization that may influence your selected healthcare issue/stressor. Critique the policy for ethical considerations, and explain the policy’s strengths and challenges in promoting ethics. Recommend one or more policy or practice changes designed to balance the competing needs of resources, workers, and patients, while addressing any ethical shortcomings of the existing policies. Be specific and provide examples. Cite evidence that informs the healthcare issue/stressor and/or the policies, and provide two scholarly resources in support of your policy or practice recommendations. /ANAPeriodicals/OJIN/TableofContents/Vol-/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html

Paper For Above Instructions

Introduction. The national healthcare issue/stressor of cost containment intersects fundamentally with the Nursing profession’s mission to deliver high-quality, ethical care while operating within finite resources. A robust framework for understanding and addressing this tension comes from value-based and quality-focused perspectives that emphasize outcomes, resource stewardship, and patient-centered care (Berwick, Nolan, & Whittington, 2008; Porter & Teisberg, 2006). In this paper, I identify two competing needs surrounding cost containment, evaluate relevant organizational policies through an ethics lens, and propose policy or practice changes designed to balance limits on resources with the obligations to patients and staff.

Two competing needs. First, patient access and affordability versus the imperative to contain costs. When budgets tighten, agencies may seek to reduce expenditures through formulary restrictions, staffing reductions, or standardized protocols. While these steps can prevent waste and promote consistency, they may also limit patient access to necessary therapies or individualized care, raising concerns about distributive justice and equity (Berwick et al., 2008; Donabedian, 1980). Second, ensuring high-quality, safe care while managing workflow demands and staff workload. Cost containment pressures can drive throughput targets, limited nurse staffing models, or performance metrics that inadvertently increase fatigue or moral distress among nurses if care is rushed or de-prioritized. Quality improvement literature cautions that cost-cutting must be aligned with patient outcomes and safety, not pursued in isolation (Chassin & Galvin, 1998; Donabedian, 1988). These competing needs require a policy approach that preserves access and quality while using resources responsibly (Berwick, 2002; World Health Organization, 2000). Underpinning these tensions is the ethical obligation to treat patients with fairness, respect autonomy, and avoid harm, as articulated in professional codes and quality frameworks (ANA, 2015; Institute of Medicine, 2001).

Organizational policy or practice and ethical critique. In many organizations, two policy levers commonly influence cost and care: (1) formulary restrictions or cost-conscious drug procurement policies, and (2) standardized care pathways and evidence-based protocols intended to reduce unnecessary variation and waste. Formulary controls can lower drug costs and promote evidence-based prescribing; however, they may limit access to appropriate, high-cost therapies for some patients, raising ethical concerns about equity and patient advocacy if exceptions processes are not robust (OEJN/ANAPeriodicals reference; Berwick et al., 2008). Standardized pathways can improve consistency, safety, and efficiency, aligning care with best available evidence (Donabedian, 1980; Porter & Teisberg, 2006). Yet overly rigid protocols risk undermining individualized care, patient preference, and clinician judgment, contributing to moral distress if clinicians feel unable to tailor treatment to unique patient circumstances (ANA, 2015).

Ethical considerations and strengths/weaknesses. A policy’s ethical soundness rests on its balance of beneficence, nonmaleficence, justice, and respect for autonomy. Formulary constraints may promote overall system efficiency (justice) and reduce harmful polypharmacy, but can compromise autonomy and access for patients with special needs. Pathways and protocols improve safety and reduce waste, yet must preserve clinician discretion and patient-centered decision making to avoid under-treatment or impersonal care. The ethics of cost containment require transparent processes, stakeholder involvement, and ongoing assessment of impact on patients, staff, and communities (ANA, 2015; OJIN, 2018). Ethical strengths include clarity of expectations, equity in standard practices, and accountability for outcomes; challenges include potential inequities in access, misalignment with patient preferences, and the risk of tacit bias in who receives exemptions or exceptions to standard policies (Berwick, 2002; Chassin & Galvin, 1998).

Policy or practice changes. To balance competing needs, I recommend a multi-pronged policy approach anchored in value-based care, transparent governance, and ethics oversight:

  • Adopt patient-centered exception processes. Maintain formulary controls but implement formal, timely pathways for exceptions when high-cost therapies or individualized care is clinically indicated. This preserves equity while controlling costs, addressing autonomy and justice concerns (Berwick et al., 2008; ANA, 2015).
  • Implement adaptive care pathways with built-in clinician judgment. Use evidence-based pathways as a floor rather than a ceiling, allowing clinician discretion in exceptional cases. Pair pathways with decision-support tools to minimize waste while preserving personalized care (Porter & Teisberg, 2006; Donabedian, 1988).
  • Enhance governance with an ethics-of-cost containment framework. Establish an ethics review component within the cost-containment governance structure to assess policies’ ethical implications and ensure alignment with core nursing values (OJIN, 2018; Berwick, 2002).
  • Invest in transparent communication and patient engagement. Ensure patients understand policy rationales and trade-offs, fostering trust and informed consent around cost-related decisions (Berwick et al., 2008; IOM, 2001).
  • Link cost-containment policies to quality metrics and outcomes research. Align incentives with value and outcomes rather than volume alone, using continuous quality improvement cycles to monitor unintended consequences and adjust as needed (Donabedian, 1980; World Health Organization, 2000).

Evidence informing the issue and policy support. Foundational frameworks emphasize balancing cost with care quality and patient outcomes. The Triple Aim framework argues for simultaneous pursuit of improved population health, patient experiences of care, and reduced per-capita costs, which directly informs cost-containment policy design (Berwick, Nolan, & Whittington, 2008). Value-based care concepts further support aligning incentives with outcomes and reductions in waste (Porter & Teisberg, 2006). Quality-of-care scholarship cautions that measurement and improvement efforts must be aligned with meaningful patient outcomes to avoid unintended harm, resistance, or inequities (Donabedian, 1980; Donabedian, 1988; Chassin & Galvin, 1998). The ethical lens provided by professional nursing ethics (ANA, 2015) and the OJIN discussion on Ethical Nursing Cost Containment offers practical considerations for balancing fiscal stewardship with patient rights and professional duty (OJIN, 2018). Finally, global health perspectives remind us that cost containment must be contextualized within health system performance and equity goals (WHO, 2000; IOM, 2001). Based on these sources, the recommended policies aim to preserve access and quality while ensuring responsible stewardship of resources (Berwick et al., 2008; Porter & Teisberg, 2006). For scholarly grounding, two resources particularly informative for policy and practice recommendations are the Triple Aim framework and the value-based care paradigm (Berwick et al., 2008; Porter & Teisberg, 2006), complemented by ethics-focused analyses (ANA, 2015; OJIN, 2018).

Conclusion. Implementing cost-containment strategies that respect patient autonomy, equity, and quality requires careful design, ongoing evaluation, and ethical governance. By combining exception-based formularies, flexible care pathways, transparent governance, and patient engagement, organizations can better balance competing needs and maintain trust in the healthcare system while operating within finite resources. The integration of cost containment with quality and ethics aligns with established theoretical frameworks and empirical insights from leading health policy scholarship, offering a path toward sustainable, patient-centered care.

References

  • Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The Triple Aim: Care, health, and cost. Health Affairs, 27(3), 759-769.
  • Porter, M. E., & Teisberg, E. O. (2006). Redefining Health Care: Creating Value-Based Competition on Results. Boston, MA: Harvard Business School Press.
  • Donabedian, A. (1980). Explorations in Quality Assessment and Monitoring. Milbank Quarterly, 58(4), 691-729.
  • Donabedian, A. (1988). The quality of care: How can it be assessed? JAMA, 260(12), 1743-1748.
  • Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press.
  • Chassin, M. R., & Galvin, R. W. (1998). The politics of quality improvement. Milbank Quarterly, 76(2), 297-324.
  • World Health Organization. (2000). The World Health Report 2000: Health Systems: Improving Performance. World Health Organization.
  • American Nurses Association. (2015). Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD: American Nurses Association.
  • Online Journal of Issues in Nursing (OJIN). (2018). Ethical Nursing Cost Containment. Available at: /ANAPeriodicals/OJIN/TableofContents/Vol-/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html
  • Berwick, D. M. (2002). What 'quality' in health care? JAMA, 287(8), 867-874.

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