another thought provoking article. i highlighted sections of interest. roberta hit it on the mark this time. suggest we widely distribute this one to our managers and send to ceo's. all in agreement??? karen
a nurse's viewpoint
stop blaming and envision the ideal
by roberta b. abrams, rnc, ma, lcce, for healthleaders.com, oct. 22, 2001
our healthcare system needs major repairs - now! years of not-so-benign neglect have created damage such that the system as an entity may not be able to respond adequately to a public health disaster. among the symptoms of this crisis in care are the numbers of healthcare delivery systems facing fiscal disaster, the hemorrhage of healthcare providers, including nurses, physicians, pharmacists, and rehabilitation therapists, and the ever-dwindling numbers of people interested in careers in healthcare.
there are many who share the blame for the current state of healthcare, including myopic healthcare administrators, irresponsible fiscal agents, inadequate and poorly prepared providers, greedy malpractice attorneys and, of course, the federal government, which sought to balance the budget on the back of the healthcare system. state governments whose leaders legislate greater services with fewer resources share in the culpability of the system.
there is a penchant that many of us share: when something goes wrong, the first thing we fix is the blame. there is plenty of blame to distribute, but its distribution will not serve any useful purpose. let us, therefore, turn our energies and our attention to requisite repairs. the reparations begin with a vision. here is one, from a nurse's viewpoint.
healthcare is not delivered by a system. people deliver healthcare.
my vision of the ideal healthcare system begins with those people. envision, if you will, a populace of healthcare providers who are all well prepared for the responsibilities of their positions. add to that a commitment to each other, to the system to which they belong, and, most importantly, to the patients for whom they care. in the ideal facility, all staff members share a sense of belonging - and a pride in what they do.
administrators in the ideal facility are women and men of vision, knowledge, and ability. in the ideal care facility, the administrators facilitate the continued growth and development of their staff. they do so by providing staff with opportunities to attend professional conferences, staff meetings, and other growth-oriented events. the administrators see themselves as nurturers, and express this by meeting with different members of the staff on a regular basis to determine needs and opportunities. they further the abilities of the staff by working with them to develop well-reasoned plans for continuous improvement for the facility and for the staff.
in the ideal care facility, governance is shared. leadership in any given project is vested in staff members who have greatest ownership of that project. teams form regularly to develop and implement improvements in care. patients, as interested consumers, are invited to provide input into plans for proposed change. as the improvements are implemented and evaluated, input is sought from all involved. when the desired outcome is achieved, the team celebrates and dissolves.
staffing for all clinical units is the responsibility of the involved staff. patient care units have established patterns for staffing which are programmed into a computer and adjusted for changes in patient census and acuity. units with similar types of patients are paired and share staff, thus avoiding "floating" staff to units for which they are unprepared. all unit leaders focus on the needs of their staff so that retention replaces recruitment as a facility activity.
the ideal facility views the patient as a valued guest. staff members within the facility work together with patients and their families to produce an optimal possible outcome to each episode of care. clinical staff formulate and modify care maps predicated on the patients' diagnoses to ensure that all necessary interventions are accomplished in a timely manner. plans for care after discharge and requisite patient and family education, are produced through the efforts of all involved staff. these interventions help to ensure that patients are discharged as soon as appropriate. well-planned post-discharge follow-up usually avoids inappropriate re-admissions.
staff members in the ideal facility are dedicated to avoidance of unnecessary costs and economies of resources. their work in this effort is achieved in several arenas. the purchasing department works with caregivers and support staff to create supply efficiencies. in the perioperative suite, for example, teams of physicians and nurses meet to achieve agreement on kinds of sutures, on equipment, and on general supplies to reduce the variety of items ordered. by reducing the variability, they facilitate storage and achieve economies of scale. the purchasing department is working with other area facilities to form purchasing cooperatives.
in a similar manner, the pharmacy teams collaborate with physicians and other members of the clinical staff to reduce variations in the types of supplies and pharmaceutical agents available within the hospital. there is a team comprised of pharmacists, physicians, and nurses that meets quarterly to review the efficacy of the system and to make changes as required or requested. ordering and distribution of medications and other pharmaceutical supplies is achieved with a system of computers, pneumatic tubes, and robotics. indeed, throughout the ideal system, computers, robots, and other mechanized vehicles provide a safer, faster, and more economical delivery systems.
the ideal care facility is an essential component of the community in which it is located. through a mix of doctors, nurses, therapists, and other caregivers, the facility provides wellness care and education on a regular basis, at reasonable cost. it also provides chances for the consumers to learn about services provided and new therapies available to the community. community support groups are formed to extend care to those with specific needs. meetings with consumers in the community provide opportunities to modify services according to need.
the ideal facility sends its leaders to the government, to industry, and to third party payors. those who request provision of healthcare services must be prepared to support the realistic costs of those services. care for the indigent, the working poor, and the uninsured must be factored into reimbursement systems. healthcare administrators must have the system and clinical knowledge to share with those responsible for reimbursement. they must have the vision to foresee and plan for changing times. they need the perseverance to return to payor sources until their goals are met.
is this merely a vision? no. in my experience, i have seen parts of each of these visions actualized. they are not pipe dreams. they are visions for what should be, what must be, if we are to create and maintain a system for healthcare that ministers to the needs of our clients, our support and delivery systems, and ourselves.