The Policy Process: Strategies for Increasing Consumer Participation

When we consider strategies for increasing consumer participation in the policy process, it is important to understand that the persons who are in charge of making decisions for healthcare related interest groups and organizations have the following levels of power available to them: power based on expertise, positional power, and power based on the capacity to reward or compel (Longest, 2010). Until taking this course on Health Policy and Innovation, my ability to impact and/or my personal influence on policy making was something that I was very naive to. It seems that most people do not think their opinion really matters, or they don’t understand how government impacts their lives (Kraft & Furlong, 2013). As leaders in healthcare, it is imperative that the DNP is not only aware of their ability to impact policy making but that we are also active participants in making changes that will impact our profession and our patients. We have the knowledge and capacity to educate others and encourage them to become more involved with policy making, as it impacts our practice as nurse practitioners, patients, friends, families, and communities. In one way or another the policy process influences most aspects of our lives.

The strategy that has been most evident in increasing consumer participation in the policy process of eliminating or reducing trans fat has been that of advertising and food labeling. In many ways national advertising campaigns and federal food labeling requirements have educated and informed consumers of the trans fat content of their foods. While this may have decreased some trans fat intake, it has certainly not made a huge impact on reducing trans fats in the diets of the majority of American consumers. Is this because they are unaware of the deleterious outcomes of consuming trans fats? Or is it possible that consumers simply do not care about the negative impacts that trans fats can have on their overall health? What will make people want to change and improve their health?

Preventing disease and promoting healthy lifestyles are standards of nursing practice (American Nurses Association, 2010).  To get involved with policy changes and change the obesity epidemic, the ANA encourages nurses to educate, advocate, and create partnerships.

References

American Nurses Association (2010).  Fighting childhood obesity: Taking a stand to control and epidemic one child at a time.  Retrieved from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs/Childhood-Obesity.pdf

Kraft, M. E., & Furlong, S. R. (2013). Public Policy: Politics, Analysis, and Alternatives (4th ed.). Thousand Oaks, CA: CQ Press

Longest, B.B. (2010).  Health policymaking in the United States (5thed.).  Chicago, IL: Health Administration Press.

SUSTAINING INNOVATION & CONSIDERATIONS OF TIME AND SCOPE

This week we will discuss how an organization or a policy change can sustain an innovative environment. We cannot easily command innovation to occur. Innovation needs to be weaved into the fabric and culture of an organization. It requires an investment of time coupled with human and financial resources. As healthcare providers, our time is already a precious commodity and is often accounted for by the tasks, patient loads, and necessary charting. The concept of innovation is something we typically associate with ideas and implementations on a large scale. As discussed in previous weeks, the Affordable Care Act (ACA) will place an unprecedented strain on healthcare practitioners to meet the healthcare needs of thousands. Thus, the success of the ACA is dependent upon our ability as practitioners to meet this demand while continuing to provide high quality care. Policymaking is ongoing because new issues will continue to arise. Existing policy must be reviewed to determine if it is still effective and meets the purpose for which it was designed. This continued review is especially true of health care policies. Emergence of new health technology, changes in the Federal budget, and the impact of the Affordable Care Act are all reasons for policy creation and modification (Longest, 2010).

Modification takes place through regular review and when a stakeholder or a special interest group steps up. Policy feeds back into the policymaking cycle and stimulates continued policymaking (Longest, 2010). Reading about policy modification has solidified my thoughts on how important the evaluation phase of policy making is and that only through innovative modification can real strides be met. The role of oversight actors in important, specifically those at the executive branch level and how they influence bringing forth policy agenda items, and they are also instrumental in policy implementation and modification (Longest, 2010, p. 170). The policy analysis of “before-and-after comparisons” is a similar method that can be utilized when comparing pre and post outcomes of eliminating trans fat from dietary intake (Longest, 2010, p. 174).

We are still a long way off from seeing a nationwide trans fat elimination, but we have seen success in outcomes in some major areas like decreased cholesterol levels and a decline in cardiovascular related deaths (Angell et al., 2009)  in cities like New York who have an implemented policy of zero trans fat. The more success and positive health outcomes that we can account for from this campaign to eliminate trans fat, the greater the impact we can have on making this a national policy. It is imperative that we continue to look at the healthy outcomes of these preventive measures so that we can build upon the case for eliminating trans fat and improving the overall heart health of our country. These steps will need to take place in order to sustain the innovative policy changes of reducing and/or eliminating trans fats.

As healthcare practitioners we also need to be aware of our responsibility to educate and inform our patients of the risks and associated   outcomes of poor lifestyle choices that they make such as diet and activity (lack of). We have the ability to recruit stakeholders and impart the need for policy changes within our local, regional, and national legislative stakeholders. We need to be the leaders that will continue to improve the health of our nation and impact policy changes that will sustain this innovation!

Reference

Angell, S. Y., Silver, L. D., Goldstein, G. P., Johnson, C. M., Deitcher, D. R., Frieden, T. R., & Bassett, M. T. (2009). Cholesterol control beyond the clinic: New York City’s trans fat restriction. Annals of Internal Medicine, 151(2), 129-134.

Longest, B.B. Jr. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

Healthcare Financing: Preventive Care and Eliminating Trans Fat

This week’s topic of healthcare financing has many applications to those health policies influencing preventive healthcare services and strategies. Most of the assigned readings explained the federal budget processes and how particular branches of the government finance entitlement programs and how discretionary programs and institute changes increase or decrease the tax code. The president’s budget request and budget accounts can stipulate priority programs that he believes should receive funding. Among these budget accounts are health and education (Longest, 2010). Since the enactment of the Affordable Care Act (ACA) in 2010, we know that expanding healthcare coverage to millions of individuals will have a tremendous fiscal impact on the United States (U.S.) healthcare system. Since the beginning of Medicare and Medicaid in the 1960s this reform has been the largest change in this U.S. healthcare financial system (Kovner & Knickman, 2011).

Several organizations, including the Obesity Action Coalition (OAC), are enthusiastically involved in lobbying Congress to address preventive care measures. The Preventive Health Savings Act is explicitly valuable in the issue of determining the cost and savings that may be related to preventive health. The Congressional Budget Office (CBO) governs the financing of a program in a piece of legislation over a 10 year time frame. The OAC’s concern is that the advantages of preventive healthcare spending for chronic diseases do not always fit into those time constraints. Programs that reduce obesity or decrease complications from chronic disease states often need longer than 10 years to show their full economic or cost-savings potential. The OAC explains that without being able to credit prevention programs for long-term budgetary savings, the existing CBO scoring method for prevention-related bills grossly misleads the influence that these programs have on federal spending.

There are some unique and disturbing insights into the costs of including or eliminating trans fats in the United States. A major argument of the food industry in not wanting to remove or decrease trans fats is the associated increase in associated costs (Browne, 2013), but others have disputed that the costs of food production would have little to no change at all (BanTransFats, 2013). An interesting fact is that some food chains, like McDonald’s, have great inconsistency within their own policies and their menu in come countries prohibits the use of trans fats while other countries it is an ingredient found throughout their entire menu (Lewis, 2011). Why is such a large contradiction permitted? The locations where trans fats seem to be more prominent are due to a lack of consumer awareness, a lack of education regarding food content and nutritional value, and a lack of funding to promote change in health policy. Funding preventive care measures should be a major focus in  primary care and as leaders in healthcare, we should promote awareness of these issues.

References

BanTransFats. (2013). The campaign to ban partially hydrogenated oils. Retrieved from http://www.bantransfats.com/

Browne, J. (2013). FDA’s transfat ban may boost food prices. Retrieved from http://triblive.com/business/brownebusiness/5032356-74/trans-fats-fat#axzz3WgaIxK00

Kovner, A. R., & Knickman, J. R. (2011). The current U.S. healthcare system; Health policy and health reform. In V. D. Weisfeld, & S. Jonas (Eds.), Health care delivery in the United States (10th ed.). New York, NY: Springer Publishing Company, LLC.

Lewis, T., & Potter, E. (Eds.). (2011). Ethical consumption: A critical introduction. Routledge.

Longest, B. B. (2010). Health Policymaking in the United States (5 ed.). Chicago, Illinois: Health Administration Press.

Obesity Action Coalitian. (2013). Obesity Care Continuum Supports Preventive Health Savings Act. Retrieved from http://www.obesityaction.org/wp-content/uploads/0214-OCC-LOS-for-Preventive-Health-Savings-Act.pdf

CHARACTERISTICS OF INNOVATORS AND CHANGE AGENTS IN THE HEALTHCARE SECTOR

This week we will talk about innovators and change agents in healthcare. Innovation in healthcare systems is a process that seeks to address complex health and non-health related issues in the healthcare industry, devising new strategies and technology to target these issues; it is the driving force of change in the healthcare system (Weberg, 2009). The concepts of self- organized, relational, and empowering can be defined as the innovation that is needed in order to meet the demands of society and improve patient care outcomes through an improved educational experience and collaboration as new graduates integrate into the profession of nursing (Brown, 2009).

Porter O’Grady and Malloch (2011) assert that characteristics of an innovative leader include:

  • Thinking “out of the box”
  • Listening carefully and acting at the when the time is appropriate
  • Challenge status quo, routines, barriers and unnecessary processes
  • Create a safe space for debate and ongoing dialog
  • Move ideas into actions. Move processes to outcomes

Thinking about this week’s topic allowed me to reflect on my recent discussion with Stephen L. Joseph who is the founder, President and CEO of BanTransFats.com, and also represents the organization as its attorney. Mr. Joseph is well known in the campaign efforts to reduce and eliminate trans fats. Before delving into the theoretical characteristics of innovators, describing my observed experience with Mr. Joseph is constructive. From the very beginning of my interaction with Mr. Joseph, it was evident that he exhibited many characteristics of a genuine innovator who integrated the principles of authenticity, complexity, productivity, and team leadership theories.

My discussion with Mr. Joseph generated my rumination as to what theory or model might provide an effective way to create change on federal level, such as the proposed trans fat policy change. One appropriate model for organizational change discussed by Van de Ven and Hargrave (2004) is that of social movement theory. Van de Ven and Hargrave summate the basic foundation of social movement. The foundation is described as political opportunities, framing processes, and mobilizing structures, that all possess the potential to influence the collective action. There are several models and theories that could be used to facilitate the agenda of reducing or eliminating trans fat. The advantage to this model is the adaptability of social structures to impact change and innovation.

The Doctorate of Nursing Practice (DNP) degree movement in nursing has been considered innovation by many (Chism, 2010). Recent advancements made in the nurse practitioner (NP) profession and in NP scope of practice are direct results of innovators who generate and translate idea into action. Innovators are those who find new pathways for improvement, advancement and achievement. The DNP degree is a driving force of innovation within the nursing profession and healthcare industry. Through their education and training, DNP graduates are becoming better equipped to make a profound difference in areas of clinical practice, leadership, and policy-making.

Reference

Brown, D. G. (2009). An interdisciplinary collaboration in nursing education. Teaching and Learning in Nursing, 4, 52-55. doi:10.1016/j.teln.2008.09.006

Chism, L. A. (2010). Leadership, Collaboration, and the DNP Graduate. The doctor of nursing practice: A guidebook for role development and professional issues. Sudbury, Massachusetts: Jones and Bartlett Publishers.

Porter-O’Grady, T., & Malloch, K. (2011). Thriving in Complexity. Quantum Leadership: Advancing innovation, transforming health care. Sudbury, MA: Jones & Bartlett Learning

Van de Ven, A. H., & Hargrave, T. J. (2004). Handbook of organizational change and innovation. In M. S. Poole, & A. H. Van de Ven (Eds.). New York, NY: Oxford University Press.

Weberg, D. (2009). Innovation in healthcare: A concept analysis. Nursing Administration Quarterly, 33(3), 227-237

Change Theory: Recommendations & Directions for the Future

To understand the process of change in regards to health policy, we need to initiate a discussion on change theory. Poole (2004) describes change as being planned or unplanned and also explains that change has elements of uncertainty. Change, tempo, rhythm, and pattern are all key terms (Poole) and can be identified in the this week’s assigned reading pertaining to the “primeval soup” where new and existing elements come together to influence policy change (Kingdon, 2011, p. 117). The path of health policy is greatly influenced by the ever changing waters of the “national mood, election results, changes of administration, changes of ideological or partisan distributions in Congress, and interest group pressure campaigns” (Kingdon, 2011, p. 162).

Fielding & Briss (2006) point out that by influencing health policy with evidenced based practices (EBP) changes have lead towards many advances in medicine and have brought about instrumental changes that have helped decrease infectious disease, increase access to treatment, and improved overall patient care. Policy makers need to be influenced by evidence in order to make the most informed decision. Unfortunately, influence may not be substantial enough to make the change in implementing EBP into health policy and it is not until enough voices are heard that the change theory can move foreword.

There have been many proposed strategies to help influence evidenced-based policy making decisions.  Liebman (2013) discussed a method and believes that there should be a federal pay by success program that would allow the policy makers to be paid and allowed to work if they have success with their position. This type of program would be promoting that the most optimal evidenced based outcome is reached at any given time. In the article from Liebman, it is discussed that pay by success was for state and local activity but this could be applied to officials in charge of policy making as well or even at a federal level. This is only one such solution to help change for the future. Change has many proposed methods but EBP in regard to health policy is a step that seems only fitting since health care advances are more grounded in EBP.

Where does trans fat fit in? Eating foods that contain trans fat, such as cookies, pizza, doughnuts, cakes, and many other snack foods, are directly linked to developing heart disease and an increased mortality rate (Kiage et al., 2013). It is because of evidence based research we know that trans fat consumption raises our low density lipoprotein (LDL), or “bad”, cholesterol and also reduces our high density lipoprotein (HDL), or “good”, cholesterol (Vesper et al., 2012). We also know that trans fat has been linked to developing obesity, heart disease, strokes, and type 2 diabetes. It is thanks to this type of research that the Food and Drug Administration, the World Health Organization, and the American Heart Association have all made recommendations to reduce trans fat consumption and have greatly impacted the health policy as it relates to banning trans fat.

References

Feilding, J., & Briss, P. (2006). Promoting evidence-based public health policy: Can we have better evidence and more action?. Health Affairs25(4), doi: 969-978; 10.1377/hlthaff.25.4.969]

Kiage, J. N., Merrill, P. D., Robinson, C. J., Cao, Y., Malik, T. A., Hundley, B. C., & Kabagambe, E. K. (2013). Intake of trans fat and all-cause mortality in the Reasons for Geographical and Racial Differences in Stroke (REGARDS) cohort. The American journal of clinical nutrition97(5), 1121-1128.

Kingdon, J. W. (2011). Agendas, alternatives, and public policies (Updated 2 ed.). London, United Kingdom: Longman Publishing Group.

Liebman, J. (2013). Building on recent advances in evidence-based policymaking. Results for America,https://myasucourses.asu.edu/bbcswebdav/pid-8843701-dt-content-rid-33354252_1/xid-33354252_1

Poole, M. S., & Van de Ven, A. H. (Eds.). (2004). Handbook of organizational change and innovation. New York, NY: Oxford University Press.

Vesper, H. W., Kuiper, H. C., Mirel, L. B., Johnson, C. L., & Pirkle, J. L. (2012). Levels of plasma trans-fatty acids in non-Hispanic white adults in the United States in 2000 and 2009. JAMA307(6), 562-563.

Policy governing access to data and privacy protection in an electronic and genomic age

While banning trans fat has been at the forefront of my weekly topics, this week we will be taking a slight detour as we discuss an important aspect of modern healthcare: access to data, privacy protection, and electronic health records (EHRs). The key points from the readings this week focus on electronic health records, privacy protection, direct-to-consumer (DTC) genetic testing, and at what level these policies regarding health information are regulated. The healthcare documentation laws expanding to electronic medical records (EMRs) and the vulnerability of patient confidentiality and protection is a delicate balance. These transitions have caused a significant concern for health care consumers to keep their health records protected and private.

Established in 1996 and then reformed a few years later, The Health Insurance Portability and Accountability Act (HIPPA) or “The Privacy Rule” is a set of federal rules that govern how health information is utilized and disclosed (Pritts, 2008; U.S. Department of Health and Human Services, 2014). Pritts (2008) echoes the importance of maintaining patients’ basic right of privacy as a necessary component to human well-being. Privacy and protection of records also advocates for personal autonomy, individuality, and self-respect (Pritts, 2008).

DTC genetic testing has come under much scrutiny as it is growing more popular in the United States (US). Due to growing consumer interest, greater awareness of the Human Genome Project, and the American consumers’ desire to access self-governed healthcare, many companies began offering genetic testing directly to the public. One issue with this type of advanced technology availability is that the majority of these DTC genetic tests do not have any pre-market review requirements nor do they need approval from the Food and Drug Administration (Hogarth, Javitt, & Melzer, 2008). Although several of the large professional organizations such as the American Medical Association (AMA) support genetic testing performed without a licensed health care professional (Caulfield & McGuire, 2012), perhaps this is an area that advanced practice nurses need to step in and advocate on behalf of the patient and demand expert consultation in order to disseminate the results. Comprehensive genetic testing should include consultation with a healthcare professional and an evaluation including the implications of the results. Are advanced practice nurses better equipped to fill this professional role? With the questionable validity of these companies, lack reputability of the DTC tests, and absence of medical counseling it is easy to see how consumers could easily be misled into making inappropriate health care decisions. It seems that the only way to get consistent regulation throughout the US is by way of federal regulation, but currently DTC genetic testing is dealt with on a state to state basis.

Some may argue that disallowing the consumer access to data, EHRs or DTC genetic testing we would be infringing upon an individual’s right to information or technology. Information is not necessarily a bad thing, but the sensitive nature of healthcare information needs to be dealt with in a way that consumers understand the information that they are receiving. If information lacks understanding, it cannot be thought of as knowledge!

References

Caulfield, T., & McGuire, A. L. (2012). Direct-to-consumer genetic testing: Perceptions, problems, and policy responses. Annual Review of Medicine, 63, 23-33.

Hogarth, S., Javitt, G., & Melzer, D. (2008). The current landscape for direct-to-consumer genetic testing: legal, ethical, and policy issues. Annu. Rev. Genomics Hum. Genet., 9, 161-182.

Pritts, J.L. (2008). The importance of value of protecting the privacy of health information: The roles of the HIPPA privacy rule and the common rule in health research. Retrieved fromhttp://www.iom.edu/~/media/Files/Activity%20Files/Research/HIPAAandResearch/PrittsPrivacyFinalDraftweb.ashx

U.S. Department of Health and Human Services. (2014). Indian health service: Health insurance portability and accountability act (HIPPA). Retrieved from http://www.ihs.gov/hipaa/

Private Sector Innovation and Trans Fat Policy Advancement

What does innovation mean to you? Who has are the innovators of policy?

  • The United States (US) Department of Commerce described the private sector as an instrument of innovation (2012) that is fueled by a competitive and free-market American economy which propels the innovative spirit of our country.
  • Although innovation can be thought of as either process or a product, in health care it is typically viewed as a product (Lanier, 2013)
  • Windrum & Koch (2008) explain that many people wrongly believe that the private sector develops innovations when the public sector is lacking the ability to be innovative.

The US government plays an indisputable role in health policy making and “…its role as a provider of health services in government facilities, most of the resources used in the pursuit of health in the U.S. are controlled by the private sector” (Longest, 2010, p. 8). According to Orient (2010) the private sector has more funding at their disposal, less legal formalities to overcome, and a greater influence than government on Americans’ thoughts and perceptions. The more that is read about public sector versus private sector involvement in policy making, the perceptions of the two sides varies greatly depending upon the source. In some literature it seems that they place responsibility and power on the public sector (government) and other readings seem to believe that it is the private sector (businesses, organizations, corporations, retail stores, etc.) that are in control. Often the research that is conducted is also largely affected by who is backing it, private or public. The research, especially in regards to the food industry, can have a huge impact on what policy making decisions are made and will often persuade or dissuade the policy agenda. The food industry has been known to involve itself in research at times when the findings would promote their products (Mercola, 2015) but in rare cases like that of trans fat, the food industry has proven that they can be persuaded by research that their products or process may need to be changed or improved upon.

The World Health Organization (WHO, 2015) acknowledged that through product reformulation that the private sector can contribute to limiting the amount of saturated and trans fats in processed foods. The WHO also believes that it is the role of the private sector to review the established marketing strategies to children in particular with those foods that contain unhealthy ingredients such as trans fats. Currently the issue of banning trans fat does seem to have gained most of it’s victories through the private sector. These initial victories then allowed them to gain the media attention and public interest which led to continued victories among the public sectors. It seems to me that if the public and private sectors were more willing to collaboratively work for the sake of improving the health of society, then this would be a true display of innovation.

“To ensure meaningful change takes hold, government and industry must collaborate” (University of Western Ontario, 2010).

References

Lanier, J. A. (2013). Leading innovation: Insights on organizational structure. Strategic Leadership Review, 3(2), 16-22

Longest, B.B. Jr. (2010).  Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

Mercola, J. (2015). The unexpected implications of industry involvement in trans fat research. Retrieved from http://articles.mercola.com/sites/articles/archive/2015/02/22/trans-fat-research-bias.aspx

Orient, J. M. (2010). Testimony on the Influence of Private Foundations on Public Policy. Journal of American Physicians and Surgeons, 15(1). Retrieved from http://www.jpands.org/vol15no1/orient.pdf

University of Western Ontario. (2010). Food and health: Advancing the policy agenda. Ontario, Canada: Author.

U.S. Department of Commerce. (2012). The competitiveness and innovative capacity of the United States. Washington, D.C: Author.

Wilde, P. (2013). Food policy in the United States: An introduction. Routledge.

Windrum, P. & Koch, P. M. (Eds.). (2008). Innovation in public sector services: entrepreneurship, creativity and management. Edward Elgar Publishing.

World Health Organization. (2015). Global strategy on diet, physical activity, and health. Retrieved from http://www.who.int/dietphysicalactivity/childhood_private_sector/en/