CHAPTER 15 FUTURE TRENDS AND CHALLENGES FUTURE TRENDS In this chapter, we identify, describe, and discuss future trends and challenges associated with the Care Coordination Clinical Reasoning (CCCR) model proposed in this book. Transformation and redesign of a 21st-century health care system requires understanding the driving forces that make a difference between change and transformation. Change efforts focused on the past may or may not help create inspired futures. Transformation is about creating a desired future and requires futures literacy. Futures literacy invites people to create and share stories about the future to inform current practice and realities. Advanced practice clinicians ought to have some grasp of anticipated future trends and consequences related to the work that they do. The National Center for Healthcare Leadership convened futurists to discern trends related to the state of health in the 21st century. Here are some of the trends futurists believe are likely: • The United States will become part of a global system focusing on wellness and preventive care worldwide. • Patients will receive care from “virtual” centers of excellence around the world. • Deeper understanding of the human genome will create exciting new forms of drugs that will prevent disease from developing. Treatment will evolve from disease management to prevention or minimization. • As people become senior citizens the issue of rising costs, resource allocation, and priorities will be exacerbated. • Fueled by access to information through the Internet, people will take more responsibility for their personal health decisions and demand that the system treat them as customers rather than users. • Most Americans will receive care from specialized centers for chronic diseases (cancers, women’s health, heart, etc.) • Standard diagnostic health will largely be electronic, with people conducting their own “doctor visits” from home through miniature data-collection and monitoring devices. Practicing nurses will have to be flexible and open to changes that may come to the forefront of health care quickly and lead the way in care coordination. Their leadership skills will have to be honed and current in order to be flexible in guiding patients and other providers through these changes. The National Center for Healthcare Leadership (2015) has developed a Leadership Competency model that focuses on three essential domains and defines 26 competencies within those domains that demonstrate the essential skills and competencies for future leadership. The domains and competencies are: • Transformation that supports visionary thinking, and that energizes, and stimulates change processes that engage people and communities in the design and development of new models of health care and wellness. Competencies that support this domain are a strategic orientation, innovative thinking, information seeking, analytic thinking, a community orientation, financial knowledge management, and an achievement orientation. • People skills that engage and energize employees in service of valuing people’s capabilities and appreciating the impact and influence that people have on each other and on stakeholders with whom they engage. Competencies that support this domain are relationship building, interpersonal understanding, professionalism, self-confidence, self-development, talent development, team leadership, and human resources management. • Execution of the skill and abilities to translate vision and strategy into organizational performance. Competencies that support this domain are organizational awareness, change leadership, impact and influence, accountability, collaboration, communication skills, initiative, information technology management, performance measurement, process management/organizational design, and project management. In addition to the national Leadership Competency models that exist, the American Nurses Association (ANA) has established a leadership institute and developed a leadership competency model that supports quality, safety, and evidence-based practice. The ANA Leadership Competency model builds on the following standards of nursing performance competency expectations associated with collaboration, communication, education, environmental health, ethics, evidence-based practice and research, leadership, practice evaluation, quality nursing practice, and resource utilization (ANA, 2013). The ANA Leadership Institute Competency Framework is organized around the belief that nurse leaders must actively lead themselves, lead others, and lead the organizations in which they work. Leading self requires adaptability, flexibility, being open to influence, projecting an executive image, motivating self, building relationships with integrity, maximizing learning, and self-awareness. Leading others requires effective communication skills, building collaborative relationships, communicating effectively to leverage differences, managing competing values, and developing and empowering others. Leading the organization requires systems thinking, business acumen, and the ability to turn vision into action through project management skills, sense making, and decisiveness as leaders navigate change. Each of the competency clusters are defined, described, and linked with specific behavioral objectives that help one craft a professional leadership development plan. The purposes of education programs will change as curricula are designed to prepare future health care providers for these domains and for mastery of the related competencies. New pedagogies and models of instruction in clinical reasoning will be required to prepare the workforce. Couple these future trends with the work of the Institute for the Future for the Phoenix Research Institute which identified six drivers and 10 skills necessary for a 2020 workforce. The drivers are increasing global life spans, the rise of smart machines and automation, an increase in sensors and big-data collection, new media tools and literacy expectations, and social technologies that connect communities of practice, learning, and research. These drivers require advance skills in order to be successful in the evolving and developing workforce. Essential 2020 workforce skills include: • Sense making: ability to determine the deeper meaning or significance of what is being expressed. • Social intelligence: ability to connect to others in a deep and direct way, to sense and stimulate reactions and desired interactions. • Novel and adaptive thinking: proficiency at thinking and coming up with solutions and responses beyond that which is rote or rule based. • Cross-cultural competency: ability to operate in different cultural settings. • Computational thinking: ability to translate vast amounts of data into abstract concepts and to understand data based reasoning. • New media literacy: ability to critically assess and develop content that uses new media forms, and to leverage these media for persuasive communication. • Transdisciplinarity: literacy in and ability to understand concepts across multiple disciplines. • Design mind-set: ability to represent and develop tasks and work processes for desired outcomes. • Cognitive load management: ability to discriminate and filter information for importance, and to understand how to maximize cognitive functioning using a variety of tools and techniques. • Virtual collaboration: ability to work productively, drive engagement, and demonstrate presence as a member of a virtual team. The authors believe that the CCCR model proposed in this text supports the development and mastery of the projected future workforce skills. In specific, the model supports sense making through the application and reinforcement of critical-, creative-, systems-, and complexity-thinking skills. The model values inclusion and social intelligence concerning patient preferences and team and interprofessional dynamics. The model supports adaptive and novel thinking based on analysis and synthesis of competing values and relationships between and among competing nursing care needs and concurrent International Classification of Diseases (ICD)-10 diagnostic categories. The model underscores the importance of cultural considerations in care planning. Data related to diagnostic tests and medical services and testing influence and inform computational thinking. The challenges of electronic health record use and new forms of communication with patients and team members as well as providers across service delivery lines, necessitates the development of new media literacy skills. The different levels of perspectives highlighted in the model encourage transdisciplinarity as clinicians consider patient-centered, team-centered, and health care system–centered issues and challenges. The activity plans associated with practice issues, interventions, and outcomes as well as the negotiation of competing values and roles and team relationships support interprofessional collaboration and teamwork. The creative thinking required in the model supports a design-thinking mind-set. Attention to the issues of framing, filter, and focus relate to cognitive load and knowledge management. Finally, the evolving nature and use of electronic health records and the rise of consumerism in regard to self-management and expectations of shared health care information (Topol, 2015) will drive developments in virtual collaboration and communication. Digital health futurists Rohit Bhargava and Fard Johnmar (2013/2014) have identified three themes and 15 trends that will influence health care and care coordination clinical reasoning into the future. The first theme is health hyperficiency, which is emerging as a result of innovations in computing. The first trend within this theme relate to empathetic interfaces as health technologies become more intuitive and human-like. A second trend in this category is unhealthy surveillance, which relates to the fact that more health data is being collected about individuals, families, and communities—such massive data collections raise issues about privacy and security. A third trend in this category is predictive psychohistory—because big data and powerful computers are being used to generate and make small- and large-scale predictions.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
