As the end of 2009 approaches, it seems a good time to reflect on one of the most hotly debated topics of the year. No matter which side of the aisle your loyalties lie, or if they are in the middle or far sides of the aisles or even outside the room, everyone seems to have strong opinions about healthcare. This will attempt to be an unbiased look into the future.
Reforming anything is a challenge in the best of situations. Schifalacqua, Costello, and Denman (2009) focus on three foundations of change theory. The power of the grapevine can sink the best laid plans, so the importance of factual information sharing is paramount to the success of any change. Americans are being bombarded by information, some accurate and some misleading, so as to confuse the issues. This practice is a common tactic motivated by profit (Wilson, 2007). An essential component in successful change is an impassioned leader and champion. Our President certainly fits this description. Whether you agree with him or not, I do not think anyone would disagree that he is passionate about the topic of healthcare reform. "Commitment is contagious. The importance of talking the talk and walking the walk is fundamental to achieving commitment to a project of any magnitude" (Schifalacqua et al., 2009, p. 27). Commitment may be the one area that is weak in the healthcare reform debate.
When you add money to the equation, the increase in complexity is exponential. Those who profit by the current system are pitted against those who stand to profit from the changes to the system. So how will healthcare reform affect you personally and your practice? Here are my 10 predictions for 2010:
1. Patients may have less disposable income for elective procedures, which are not covered by health plans. They may be paying more for their health plan, and an already-strained economy may get worse. On the other hand, the economy might get better.
2. Implementation of healthcare reform will be either hasty and painful or slow and painful. It will be painful.
3. Those who thought they understood what they were getting will be surprised and probably disappointed. In a document with more than 1,000 pages, some surprises are bound to be buried.
4. Patient satisfaction may see a drop. Both supporters and opponents will not get what they envisioned. That is the beauty of compromise.
5. Healthcare reform may not be as bad as the opponents make it out to be, but the jury will still be out by the end of 2010.
6. Physicians, nurses, and others working in healthcare may question their occupational choices as stress at work reaches an all-time high. This happens every time major change occurs in the field.
7. It will cost more than predicted...a lot more. When is the last time the government accurately predicted the cost of a program. Certainly, this has not happened in my lifetime, and I am no spring chicken.
8. There may be a large number of incumbent politicians looking for new careers after the elections. Where there is great debate, there is always fallout. The voting population tends to send messages with their votes. On the other hand, they may turn out to be heroes and heroines if reform is perceived as a great success by the majority.
9. There will still be uninsured. Whether by choice or circumstance, it will be impossible to cover everyone living in the United States with a healthcare plan.
10. There will be more paperwork. It may be electronic but there will be more.
The use of the word may in most of my predictions illuminate the fact that I am not the most confident forecaster. It will be interesting to look back at the end of next year and see if any of these predictions materialize.
Change is a fact of life in healthcare. It is driven by technology, evidence-based practices, and payment systems changes. Regardless of the specifics of healthcare reform, there are significant management functions and policies that will need to be reviewed and possibly revised. Consider the following:
* How many new patients (of the 46 million uninsured) can you expect to serve in your facility?
* Will the acuity level shift because of this new group?
* Where will the physicians, nurses, and other healthcare staff come from to treat these patients?
* Will there be an impact on current and long-term budgets, including capital budgets?
* What impact will there be on personnel and policy issues?
* What will the impact be to administrative costs?
* What new costs might be incurred to comply with new regulations?
* What kinds of new training may be needed?
* What investment might be required to implement proposed information technology?
Coping strategies for all this change may help us survive and even thrive. First, recognize that change is stressful. Then you can face the change head-on. Fear can be paralyzing and many times comes from a lack of information. Getting the facts should reduce the unknowns to a minimum. Look for the resources that can help you during the challenging times. Other people may be a good support system for you. King County (n.d.) provides some helpful hints about coping with change by identifying how you are feeling about the change and then asking some questions:
* Is my reaction justified?
* Is the intensity of my reaction justified by the facts?
* Am I overreacting or misinterpreting?
* Is there another way to look at this?
* Is there an opportunity here?
* Are there aspects of this situation that I can control?
* Would more information help me cope better with this change?
One place to look for additional information about your practice continues to be the Journal. In this issue you can learn more about clinical photography, the obsession with beauty, and a postmastectomy educational program. In the "Departments," topics include flash sterilization, hand-off communication, skin graft donor sites, and blepharoplasty practice guidelines. The upcoming changes in plastic surgical nursing practice will be many. This would be a perfect time for you to share your observations and expertise with your colleagues by writing an article for Plastic Surgical Nursing. Submissions are conveniently accepted online at http://www.editorialmanager.com, and I am very happy to mentor authors.
Please feel free to forward your comments to me and the editorial board by writing us at Plastic Surgical Nursing, American Society of Plastic Surgical Nurses, 7794 Grow Drive, Pensacola, FL 32514-7072 or send an e-mail to Candise Flippin at [email protected].
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