Like ball of threads to an unsolved...

Like ball of threads to an unsolved mystery, pieces of the health care pose surround us on a daily basis. We frequently are overwhelmed by the buzzwords or attributes associated with the mystery of health care redesign. Many times the verbiage thwarts us -- terms such as take away from containment, health care delivery order quality care, universal access, managed care, and single-payer a whole are phrases found frequently in the literature. Health care redesign is a continuous proces in which many factors will affect the final chapter of the mystery.

Escalating health care expenditures have l the US guidance to examine the health care industry critically for cost-containment measures. The congressional roll office projects that health care expenditures will describe 18% of the gross domestic yield by the year 2000 if no cost-containment measures are implemented.(1) We are searching desperately for the wisest, health care alternative, long-term delivery organization (WHALDO), still in the end, what will we find@ What are we willing to accept from health care redesign and at what cost? for what reason rigorous will the ultimate standard of "medically necessary" and "appropriate" be? Will we have to accept rationing based forward cost-effectiveness? Who will decide this? Will research efforts be limited by dint of the cost of new treatment developments?

Ethical ambivalence regarding beginning- and end-of-life care also must be addressed, although "one person's humanitarian justice in pulling the quid is another person's murder."(2) These and many other issues are at the forefront of the debate, and the carrying capacity of proof is on us as a nation to make moral and politically conscious decisions.

President Clinton's health care reform platform of 1992 called for

a monumental

transformation in this country's life

that would match any social

change we have seen since

the 1960 and perhaps since

the of the present day Deal of the 1930s(3)

Therefore, fundamental changes are being implicated. Health care redesign is an issue in which all interest clusters should be involved passionately, and single in which consumers, business, rule and health care providers will negotiate the final outcome

single of the major areas of contention in health care redesign is the perception of a government-mandated scheme Images of partisan bickering, misappropriation of stocks misconduct, and filibustering are ingrained in our minds. There are major flaws within the existing order -- problems with access, affordability, abuse, and defensive medicine -- further do we trust the management to make the appropriate changes? Now, more than eternally it is up to us as a profession to speak the political language and demonstrate a commitment to making our policymakers more responsive and accountable to health care issues.(4) The issue of health care redesign is too critical for us as a profession to be left behind, we are standing at an impasse, and we must become an integral part of the restructuring proces We have the knowledge and capability to make policy decisions, articulate our intelligence by means of research, and identify the health care be in want ofs of the public. We are in the shadows, however, because we do not recognize politics as our forte.

As a profession, we have focused in such a manner intently on the clinical arena that the political arena be seens like an intimidating maze of rhetoric that does not fit into our nursing practice. We must remember that

Health does not present itself in a

political vacuum. It is

substantially affected by way of health,

economic, [and]

environmental policies and laws.(5)

We ne to become more global in our thinking and use legal, financial, and political skills to gain resources for our clients. Is this not within our professional realm?

With the advent and realization of the reenginering proces man aged care, and capitation, perioperative care settings are being scrutinized for greater productivity, quality care, and cost-containment measures. Questions and bear upons about the necessity of surgical operations as well as the shift from inpatient to ambulatory care settings, are being voiced by dint of special interest groups. What will be the ultimate outlay be to perioperative nurses?

We must be willing to explore alternative staffing patterns for cost-containment measures, as well as examine the redundancy o tasks performed within perioperative settings. We will have to make difficult decisions that may affect perioperative festers employment. Regardless of the difficulty and challenge of the health care crisis that bring face to faces us, we must not allow dissension and discord to vast assemblage our viability and our responsibility to patients.

Perioperative feeds must be an innovative constituting of the health care labyrinth by becoming politically and publicly astute in identifying the cost-effective. quality care that we can provide. Developing powerful alliances with our communities, becoming politically visible, and communicating our knowledge of health care issues is vital to our political survival-and perhaps, as a arise we will find WHALDO!