Quality Management/ performance improvement ADVICE PLEASE!!!

[caeRn]

I posted this last week. thanks to all who replied. I just am very frustrated lil history on subject read my last post and then i will explain:

This is last week post

"I have a question? Here is a little history. I am an RN BSN. I started my career in ICU. I worked ICU for 3 years and then went to Float pool. I floated to all clinical areas of hospital for 3 years. I have just accepted a new position in Quality Management. I was approached to take this position by administraion and medical director. It is new to me but i enjoy my role so far. I work on all patient concerns/greivances, set.events, RCAs, quality assurance and performance improvement. I have really got a taste of the other side, behind the scenes kind of nursing. Anyway my question is to all the nurses working patient care, (I was one for 6yrs) Why do I get such an attitude and defence/resistance from all when asking questions about an event or patient concern. We are not there to get you in trouble. We are there to help improve quality of care and improve performance. Why is there such a resistance from the staff nurses? I am not being smart when I ask do many of you even know there is a Quality/PI Office in your hospital??? I have found from my hospital, staff doesnt know what Quality or PI is. "

I have made it a point to compliment the staff on all the positive observations I make. I have typed up notes on specific positive incidents i have witnessed and praised the staff.. I hang them in break room ofcourse without any patient identification. I also personally give the involved staff a copy and the manager. Today I go to a floor to discuss what happened when a patient left AMA. When I go to interview the staff, I make it a point to tell them I am not here to get them in trouble i am here to clear up what happened. I talked to three nurses involved in the case. Just trying to get the entire picture. They all 3 gave me a BIG old ATTITUDE!!! I am so frustrated. I am a nice person. I do not approach staff with attitude and i always reasure them I am here to help. I keep getting the same comment from staff..."You are one of them now"... I reply no i am one of you, a nurse, a nurse who worked along side of all of you, I wanted a change and got the opportunity to see nursing from the other side. I am still one of you!

arghhhhhhh!!! I do know the last person in my position wasnt very nice and always talked about the bad and didnt talk to the staff as a peer but as if she was police. I am not the darn nursing police!!! frustrated.........

sorry for typos too frustrated to check!!!

[Otessa, BSN, RN]

WOW - strong feelings. It is easy to see that a lot of folks must have had bad experiences that probably generate this type of reaction.

I think the OP is caught up in an organizational 'black hole'. It's difficult to be positive in a culture that is so adversarial. Her role seems to be that of 'internal affairs' and investigations. Sheesh. Hope she's got a flak jacket under that lab coat.

We have a different sort of approach. Anything that is associated with a potential 'loss' (like lawsuits, falls, equipment failure, employee injuries, etc) is handled by Risk Management. Our QI folks focus only on QI. I think that this provides a much better distinction. We have also been pretty successful in establishing a 'just culture' in which we focus on trying to identify and fix process breakdowns rather than figuring out who is to blame.

We have great systems for reporting 'near misses' and 'unexpected' events like AMAs. The RM folks follow up to get details of the situation. Staff who report them are acknowledged (by their managers & supervisors) for contributing to a safer and better workplace.

I've had the good fortune to work where the PI/QI department was separate from Risk Management. Combined PI/RM would not have been for me although we did have nurses who worked specifically for RM.