How Healthcare Policy is Formed

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Medical staff engaged in conversation meeting

Local, state and federal lawmakers rely on healthcare policies to protect and promote public health, but creating the policies has historically been a challenge. Often, healthcare policymaking comes as a result of lawmaker wrangling, not from medical professionals who best understand patient needs.

At its most basic level, the U.S. healthcare system consists of three elements:

  1. Frontline microsystems, such as outpatient clinics and hospital systems, with healthcare policies that represent an organization’s goals and daily activities to prevent unnecessary risks.
  2. Mesosystems that target state- and regional-level policy
  3. Macrosystems aimed at delivering healthy outcomes to millions of people and setting the tone for the healthcare marketplace.

Each of these systems works independently yet concurrently to provide healthcare throughout the country, with the federal government coordinating and overseeing all policy.

While the overall goal of healthcare policy is to achieve quality standards, improve patient safety, and promote healthy outcomes, a growing number of medical professionals fear it has become mired in politics. In many cases, healthcare policy is made with little input from the healthcare community itself.

Medical professionals are looking to make changes in how policies are formed. As a result, healthcare leaders are calling on nurses with Doctor of Nursing Practice (DNP) degrees to lead the charge in changes to healthcare policy. The American Association of Colleges of Nursing (AACN) said DNP degrees prepare nurse leaders for policy-making roles.

“Political activism and a commitment to policy development are central elements of professional nursing practice, and the DNP graduate has the ability to assume a broad leadership role on behalf of the public as well as the nursing profession,” AACN leaders said.

Micro- and Meso-Level Healthcare Policy Formation

On the smallest scale, microsystems include local hospitals and clinics that create healthcare policy for exclusive use. The guiding force in micro-level policy formation is the policy committee that often includes facility administrators and medical personnel.  The point for these committees is to act as change agents for the future of local healthcare.

While the policies are written in compliance with local, state, and federal regulations, they are also written to address workplace safety and patient wellbeing.  Formalized policies fulfill several purposes for micro-level institutions, including the following:

  • Facilitating adherence to professional practices
  • Fulfilling requirements due to regulations, statutes, and accreditation agencies
  • Reducing practice variations
  • Instructing staff
  • Reducing human error

At the same time, mesosystem healthcare policies function on the state and regional levels. Each state has healthcare regulatory agencies that follow different policies determined by local legislators. Some state-specific policies include laws that set minimum hospital stays for new mothers and babies, regulations that mandate coverage for experimental treatments, and policies that outline disease reporting.

Macro-level Healthcare Policy Formation

On the federal level, elected and appointed officials write healthcare policy with input from other professionals. Like other public-policy decisions, healthcare policy on the federal level is traditionally made through the three branches of government.

  • The legislative branch (state representatives and senators) formulates the policy
  • The executive branch (the president) approves or vetoes the legislation
  • The judicial branch interprets the policy.

The U.S. Department of Health and Human Services (HHS) manages public-health programs that include Medicare, Medicaid, and the Children’s Health Insurance Program.

Doctors of Nursing Practice and Healthcare Policy

DNPs are advanced practice registered nurses (APRNs) with masters and doctoral training. They have extensive academic and clinical experience and are prepared to make data-driven decisions about leadership and policy that will affect patients across all transcultural levels.  Major healthcare organizations such as the Institute of Medicine (IoM) are proponents for DNPs to take prominent positions in healthcare policy roles. The AACN simultaneously endorsed the DNP role as a terminal degree, or highest practice degree, in nursing. The AACN created curriculum standards for the DNP degree program to prepare students for actionable roles. Instead of focusing on bedside care, DNP education focuses on utilizing scientific research for patient care on the science, business, and management sides of nursing. DNP degree programs look to healthcare trends and strategies so nurse leaders can effectuate change.

The AACN said DNP graduates have the skills to analyze policy to “engage in politically competent action.”

“DNP graduates are prepared to design, influence, and implement health care policies that frame health care financing, practice regulation, access, safety, quality, and efficacy,” the AACN said.

The AACN also said DNP degree programs must prepare students in the following areas:

  • Leadership – Graduates must demonstrate leadership in the creation and implementation of healthcare policies on the local, state, federal, and international levels.
  • Critical Thinking – DNP-trained nurses must be able to critically examine and interpret public policy proposals and other issues related to patients, nurses, and other healthcare providers.
  • Guidance – Graduates must be able to educate other policymakers and the public about nursing and healthcare policy.
  • Advocacy – DNP nurses must be prepared to defend social justice, ethical practices, and equity in healthcare policy on local, state, and federal levels.

The leading DNP programs offer coursework in social justice, global health perspectives, healthcare policy, and healthcare framework to train health policy influencers. Duquesne University Online Doctor of Nursing Practice students are also expected to complete a personalized Doctoral Practice Project that reflects a greater understanding of healthcare complexities and their relationships to the public. The program at Duquesne University focuses on creating healthcare leaders who will improve health policies for the general population.

About Duquesne University’s online Doctor of Nursing Practice Degree Program

Duquesne University’s online Online Doctor of Nursing Practice program allows students to continue working while pursuing an advanced degree. Duquesne University’s DNP program builds on existing skills in preparation for roles in public policy, education, and leadership.

Additional Reading

Duquesne University Blog, “Patient Data In The Age of Technology Infographic”

Sources, “Improve Create Effective Policies/, ” Why Is Health Care Regulation So Complex?”
Patient Safety and Quality Healthcare, “Policies and Procedures for Healthcare Organizations: A Risk Management Perspective”, “The Future of Nursing”