Consumer-driven Outcomes

Consumers are driving their own outcomes of care and frequently have more information about their healthcare needs than do their healthcare providers. Nevertheless, patients and families, consumers of nursing care, expect that a knowledgeable, competent nurse will be available to provide services to meet their healthcare needs and help them achieve a positive outcome from their illness. The knowledge level of most consumers is greatly enhanced by their capability to seek information about their healthcare needs through the Internet. More than 110 million people use the Internet to search for healthcare information and are indeed driving their own healthcare outcomes. Consumer-driven outcomes place a formidable responsibility on all providers, but since nurses are at the forefront of providing care, the challenge to keep abreast of the continuous changes in treatment modalities and pharmaceuticals can be overwhelming.

Many other aspects of consumer-driven outcomes include living wills, end-of-life directives as well as other specified requirements of self-care. Nurse executives are the driving force throughout the country to ensure that the consumers' needs are met. Rhonda Anderson, MPA, RN, CNAA, FAAN, CHE, Chief Operating Officer at Banner Desert Medical Center in Mesa, Ariz, has graciously accepted the editorial leadership for this most timely issue of Nursing Administration Quarterly. She has been leading and mentoring the field of nursing administration throughout her career and served as president of the American Organization of Nurse Executives. Prior to moving to Arizona, Rhonda was the Executive Vice President of the Hartford Physician Hospital in Hartford, Conn. Rhonda has extensive and progressive experience in staff nursing, education, and hospital and healthcare organization management roles. She has worked in the Southwest, the Northeast, and the Midwest. This diverse experience has given her a wide range of challenges since the practice of health and illness care varies from region to region. Rhonda has written, published, and lectured on professional nursing practice models, financial management, clinical ladders, patient classification systems, managed care structure and philosophy, patient-centered care models, healthcare reform, quality management, and community health initiatives. Her current appointment as a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Commissioner has her on the JCAHO Board, Accreditation Committee, and chair of the Performance Measurement Committee. She is also a member of the American Hospital Association Quality Task Force and its Patient Safety Quality Awards Committee. Consumer-driven outcomes is her fort'e, and we are fortunate to have her as guest editor for this issue.

As I am an actively participating senior in my 70s, I know the many testimonies to my generation's concerns about the end-of-life outcomes of care. There is not a person who is approaching that treasured time in longevity of life, who wants to have others determine his or her wishes at the end of life. Yes, we have living wills, and directives, but who pays attention to us and when are we going to really enable the consumer to "direct" that outcome that is eventual for all? Recently, experts in ethics have recognized that living wills are flawed and in need of a fix as the Hastings Center Report has stated: "Enough. The living will has failed and it is time to say so." There are now 10 new proposals in Washington for bold new approaches to decision making at the end of life. Probably the most common and maybe the best is to have a healthcare proxy, someone designated in writing to speak on the consumer's behalf when the consumer is unable to. My eldest son has that awesome designation for me, and it would not be easy with 5 siblings possibly questioning him, even though I have a living will.

Another innovation comes from Oregon called POLST-Physician Orders for Life Sustaining Treatment, which is actually a doctor's order, so it holds official practice mandate and is binding. We know we have a dysfunctional healthcare system, where consumers struggle through the maze of providers in an attempt to secure the pathway to their self-directed healthcare outcome. Outcomes for cancer survivors have been found to be lacking in follow-up care. While cancer survival rates are continuously improving, there is a void in sustaining follow-up, which creates a serious risk of re-emerging and new diseases for cancer survivors. Recommendations by the Institute of Medicine state that every patient completing cancer treatment should be given a customized "survivorship care plan" to guide future healthcare. More than 10 million Americans are cancer survivors, and this number will grow as research continues to find ways to treat cancer. But what will the consumer outcome be if there is no continuing care process, as we know the immune system has been compromised and other serious health problems may occur?

It is increasingly clear that we need a more rational system of healthcare, with decency, justice, responsibility, and ethical outcomes for consumers. Leaders in nursing will make the difference in achieving quality clinical outcomes for the consumers of healthcare. Leaders develop and communicate ethical codes of behavior for their organization and for the profession of nursing. We are the forever conscience of the clinical outcomes of care for the consumer.

Barbara J. Brown, EdD, RN, CNAA, FAAN, FNAP

Editor-in-chief, Nursing Administration Quarterly