10:28 PM

your input was great.
the current vision is essentially what you said-to provide quality,affordable,comprehensive health care.at one time the vision was more on prevention and i feel we need to return to that vision. assessing outcomes is a good way to work on systems change. the outcomes have generally been positive,but there certainly have been some serious,negative outcomes.
the quality assurance idea is also a good one as the qa committees are more flexible and open to change. what i have done is become a member of the cardiac care team in the hospital. i feel that i can start to impact the system in a small way by making suggestions to this team. in my role as a psychiatric nurse on the team, i have already begun to educate them on research indicating that depressed post mi patients are 5 times as likely to have a second mi within a six month time period.i am working on this further by being creative and working to form a support group for post mi pts. their openness snd ability to adapt has helped me to be creative.the boundaries have softened. the boundaries of my boss and my dept have also softened as they are freeing my time(and their money) to work on meeting the needs of the cardiac patients.
everything is interconnected in the health care system. we sometimes forget this as we focus on the needs of a particular dept/the budget,etc. we must remember this interconnectedness and the incredible significance of relationships. relationships are essentially all there is to reality and these relationships(dept, interpersonal,etc) need to be open to the need for ongoing change .the structure needs to faciltitate the relationships. this does require faith and faith is a difficult concept to be grasped by an organization.implementing a program on a short term,trial basis as i am doing with the cardiac support group is one way to faciltitate the development of faith.
thanx again for your input