I started my nursing career as an Army nurse. In fact, I started my prenursing life in the Army. I was a fortunate recipient of the Walter Reed Army Institute of Nursing Scholarship which means my professional education took place in the (now defunct) program often referred to as the "Army's Academy for Nursing." My professors were doctorally prepared Army officers, and my clinical rotations were in military facilities, both inpatient and outpatient. I have been thinking about that education a lot lately, especially since I attended a conference where one of the speakers, a retired Navy Admiral, reminded the audience that the military has practiced population health management for over a century.
Of course, civilian health care systems have been involved in population care, too. Health Maintenance Organizations (HMOs) have much that they can teach those of us who have "grown up" in a hospital-centric world of noncoordinated, fragmented care. But even those who have not considered themselves systems, with continuum care accountabilities, may have small pockets of population health expertise within their care "products."
Discovering these internal competencies requires broadening the definition for population health management. In my early career (pre-Tricare), the Army's population was defined as active duty members of the Armed Forces and their dependents, retired military members and their families, and some members elected to the federal government. HMOs care for "members"-people from all walks of life, with all kinds of acute and chronic conditions, who have purchased the right to be part of their health maintenance organizations. Some health care systems are already managing their own employees' health through narrow networks (in which only specific providers are allowed to provide care for the employee population) and wellness programs. Others, through clinical centers of excellence or service lines are caring for patients with specific chronic conditions, across a continuum of care sites.
Populations can be identified by their health care payment systems, diagnoses, geographical locations, age, gender, race, employer, income levels, or any other shared characteristic. Health systems moving into the next generation of care have strategic decisions to make about which populations they will (or should) manage. Assuming that all providers have similar missions to maximize health and/or provide appropriate interventions, when health has been compromised, those decisions must be made, and continually reevaluated in the changing, chaotic world of health reform.
As nurse executives, we want to provide quality care to whatever populations we serve. That includes utilizing evidence-based practices in both clinical and management domains. In the health care reform era, these practices are as much about keeping people healthy as they are about nursing the sick. The Army faculty, who taught the importance of both wellness and illness care as a part of the holistic practice of nursing (4 decades ago!) would be overjoyed to see this transformation of "civilian" health care (My guess is that your university professors taught/teach the same thing and are equally excited).
I'm excited, too, about this edition of NAQ. Our authors have approached the topic of population health management from diverse perspectives. They've addressed a variety of "populations" and generously shared how their organizations have approached their care management.
Nurse leaders are gaining experience in health care systems where leadership has accepted accountability for defined populations. Isn't this a wonderful profession, where we share knowledge and learn for each other as we move into the next era of health care!
Thank you for choosing to lead.
-Kathleen D. Sanford, DBA, RN, CENP, FACHE
Senior Vice President and Chief Nursing Officer
Catholic Health Initiatives Englewood, Colorado
Editor-in-Chief
Nursing Administration Quarterly