| Rising health care costs and the nursing shortage have affected the ability of health care organizations to provide a collaborative environment for high quality care. Studies show that the nursing shortage has resulted in increased work loads, fewer support resources and nurse dissatisfaction resulting in difficulty providing quality care (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002). Henneman (1995) cited lack of collaboration as a contributing factor to fragmentation of care and poor outcomes in our health care system. Knaus, Draper, Wagner, and Zimmerman (1986) found that hospitals where collaboration was present reported a mortality rate 41% lower than predicted. Hospitals where there was little collaboration exceeded predicted mortality by 58%. Positive collaborative relations have also been tied to a decrease in negative patient outcomes, increased organizational commitment and nurse satisfaction (Mitchell, Armstrong, Simpson & Lentz 1989; Baggs et al, 1999) as well as reduced cost and greater responsiveness(D’Amour, Goulet, Pineault, Labadie & Remondin 2004).
This discussion will introduce the participant to collaboration and use of the Donabedian S-P-O model for embedding best practice components necessary for collaboration in an acute care setting. The National Joint Practice Commission (NJPC) recommendations and the work of Schmalenberg, et al. (2005) were utilized to establish structural and process components necessary for a collaborative practice environment. Trinity Medical Center utilized this information in conjunction with the Center for Case Management to develop a Care Model and improve patient outcomes. The average length of stay went from 4.24 to 3.37 and cost per admission from $6723 to $5919 in just over one year.
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