Research Paper: Diagnosis Related Groups (Drg) Systems

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[. . .] The outliers were not included in the general policy guidelines of the DRG.

This offer motivated the hospitals to accept the new system. In order to enforce the DRG system permanently in the healthcare facilities, legislation was passed which acted as the re-freezing measure.

The DRG system was designed without involvement of nursing staff. It was the product of few talented individuals who were serving at leading positions. They must have backed their designed system with many supporting facts and research, however, it lacked in consideration of many important facts and aspects. One of these factors is participation of nursing staff in its revival.

As DRG system is proposed for review in many countries of the world, it must be taken into consideration that the new system must be designed in such a manner that no stakeholder is left ignored. No entity is hurt from its implementation and it is accepted on grounds of its proven effectiveness and not imposed through legislation merely.

This suggestion is no exception as in the present world; the concept of participative management is emerging. The successful systems are the ones which are designed with participation of all stakeholders' regardless their position in the hierarchy. The level of importance attached to stakeholder must be based on its influence on the job role and not his level. The excellent results can be obtained if the closest point of contact with patient is strengthened. It is possible only through considering the concern of nursing staff and addressing them in the best possible manner.

Having discussed the background of DRG system, it deems fit to proceed to the section of its implications for nurses.

Implication for Nursing Practices

As mentioned earlier, DRG system was introduced to streamline the financial administration in hospitals and clinics. It is interesting to mention that the DRG system implementation required certain changes in the hospital systems. It is no exaggeration to mention that it was result of a series of changes to be made in the hospitals' administration procedures. These changes affected the work load of the staff and the quality of healthcare system.

Described below is the implication of DRG system for nurses.

Quality of Healthcare System

Quality of the healthcare system depends upon uncountable factors; the most important one of them is the time a patient has to spend at healthcare facility. The number of visits required can also be considered a quality determinant. It happens most commonly that the patients are invited to the hospitals multiple times, either to take medical history, collect specimen, collect reports, consult the physicians, get the medication make and follow-up visits. If the patient is not fit after passing through this process, it is evident that the healthcare services are not provided up to quality standards.

There are certain other factors which determine the quality of healthcare centers, as mentioned earlier as well. It includes behavior of the doctors, staff and nurses. The patients come into contact with nurses frequently during their treatment. It can be assumed that nurses stay in the closest contact with the patients. On the basis of the contact, certain responsibilities are assigned to them which are greater in number as compared to any other staff member at the hospital.

With the implementation of DRG, and particularly after its enforcement as legal requirement, the patients have to be included in one of the categorized defined in DRG. No doubt that there is a category that covers the case which does not fall in any categories, but all the cases cannot be included in that last category. The administrator needs to place the patient in a group which may be a time consuming process for him. Once a group is allocated to the patient, the set resources and patterns are attached with the patient. Consequently, he follows the procedure associated with that group. As a result, the medical practitioners and hospital administration lose control over the quality of healthcare services to be provided to the patient.

Each category in DRG system is assigned a code. Many of the codes are ambiguous and nursing staff does not understand them fully (Rosenberg and Brownie, 2002). The ambiguity may lead to placement of patient in a wrong group which can cause serious issues about provision of quality healthcare facilities.

Work Load of Nurses

In addition to performing the routine function of patient care, there are many support functions which are included in the job description of nurses. These support functions are related to administration which is greatly affected by DRG regulations. DRG regulations have increased the work load of nurses in administrative domain. These activities add no value to the hospital's administration except complying with DRG regulations. The end result is the nurses are not able to give proper time to the patients (Halloran, 1985).

Nurses are concerned about their performance appraisals which are to be determined on the basis of quality of healthcare provided to the patients. Nursing staff is subject to managing their routine functions in addition to the information system management that is particularly implemented because of DRG.

One of the drawbacks of DRG is its focus on cost management of hospitals ignoring the cost component of nursing staff. Nursing staff is high in number in hospitals as compared to any other staff; hence its consideration is mandatory when policies related to hospital management are devised. It must be considered that the cost management of nurses is done in a manner that enables them to perform their duties without any tension of bread and butter. As mentioned earlier, the behavior is nursing staff is one of the most important intangible factor determining the quality of services provided at healthcare facilities. If nursing staff is worried about meeting its both ends meet, it is quite possible that they cannot pay attention to their duties. Consequently, they can allocate wrong group to the patient. It is also possible that their pre-occupations hamper their ability to multitask which may result in worse conditions for patients. In either case, the hospital management calls for effective management of nursing staff. The satisfied and motivated staff can not only perform the functions effectively but can also play a vital role in highlighting the system deficiencies which act as bottlenecks on the way to achieve desired goals.

Job Opportunities for Nurses

An important issue related to DRG in the perspective of nurses is about employment opportunities. There are many hospitals which do not comply with the rate of DGR and providing healthcare services to patients at the rate which is far below the DRG rate. If DRG is implemented in these hospitals, it is quite possible that there will be no profit margin left for them and eventually they will have to wind up. The closure of hospitals is not only the loss of healthcare facility for the patients but also for nursing staff who may find it difficult to locate other means to earn bread and butter.


The system of DRG has been implemented by passing legislation, however, there is much more to be done as yet. The need for change is always present in every business settings regardless how many improvements have been made. Implementing the DRG system is just one step, much is to be done in the context of nursing.

In the light of above discussion, following suggestions are made to improve the efficiency of DRG system for nurses and healthcare industry on the whole.

In rural areas, the implementation of DRG is serious threat to the survival of medical healthcare institutes and employment of nurses. It is, therefore, of high importance that either DRG rates are revised for these hospitals or a new policy is devised that can facilitate provision of healthcare services in these areas. A suggestion in this regard can be addition of another category in DGR which particularly deals with the hospitals which operate at the rate which is below normal rates of DRG.

Though DRG system is implemented with the help of an information system, it is of utmost importance that the nurses are trained on this system so that they can enjoy the efficacy of new system in its true sense. In its present form, nurses have to spend their time in following the procedures advised by DRG systems. It was the time which was spent in patient care activities prior to the development of DRG system.

As the basic purpose behind establishment of hospitals is provision of the best healthcare facilities to the patients, all administrative functions must be designed in a manner that pave a way for achievement of the desired goal rather than deviating from it (Bull, 1988). The DRG system was introduced to benefit insurance companies but it appeared as a time consuming activity for administrative staff at hospitals. The new system did not suggest any change in the number of administrative staff… [END OF PREVIEW]

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APA Format

Diagnosis Related Groups (Drg) Systems.  (2012, October 22).  Retrieved May 25, 2019, from

MLA Format

"Diagnosis Related Groups (Drg) Systems."  22 October 2012.  Web.  25 May 2019. <>.

Chicago Format

"Diagnosis Related Groups (Drg) Systems."  October 22, 2012.  Accessed May 25, 2019.