Reflection: Healthcare Quality and Safety

The following reflection will describe my understanding of the current status of health care quality and safety and my ideas for the best way to improve patient safety. I am just finishing my third semester of the Masters of Science in Nursing program. Since I am at the halfway mark, I should be feeling like I know something more than when I came into this program.

Reflection: Healthcare Quality and Safety

The following reflection will describe my understanding of the current status of health care quality and safety and my ideas for the best way to improve patient safety. I am just finishing my third semester of the Masters of Science in Nursing program. Since I am at the halfway mark, I should be feeling like I know something more than when I came into this program. I have taken Nursing Theory (again), Nursing research (again, twice) and Decision Making. This semester I took Nursing Economics, and this course, Nursing Quality and Safety. Although this is supposed to be a reflection of the concepts learned in this course, every concept builds upon the next, just like my career experiences over the years. Instead of feeling like I know more, I feel like I know less, especially when it comes to the best way to improve patient safety.

I have been a registered nurse for ten long years, transitioning from telemetry, to step-down, to intensive care. In the interim I have obtained a baccalaureate degree in nursing, and will obtain a masters degree. I am tired- tired of task oriented nursing, tired of the hierarchical system, tired of the bullying, spitefulness, and schadenfreude that characterizes the work environment, and tired of the futility of caring for patients that will be harmed by iatrogenesis.

The yearly death toll from medical errors has been likened to a two full 747s crashing every three days, with no survivors (Millenson, 2002). That statistic is included because it illustrates two important points:

First, the hue and cry over jet airliner crashes has resulted in exhaustive investigations and systemic changes that have made air travel one of the safest modes of transportation available. Yet the above statistic was first publicized in 1994, almost twenty years ago, and not much has improved in the healthcare system. There have been changes, to be sure, but no improvement. The most recent statistics for those harmed by medical errors are even more staggering; we now kill the equivalent of four fully loaded jumbo jets a week (Macary, 2012).

The major difference between air travel and healthcare is that people do not have to fly. They can chose to drive, take a bus or train, or stay home. I believe the disparity between these industries exists for the same reason that, while Toyota is one of the most efficient companies in the auto industry, the adoption of "Lean" has not helped the healthcare system People have a choice which airline to fly or car to drive. The majority of patients did not have a choice whether they were hospitalized or where. Many were taken by ambulance to the nearest facility. Most facilities are paid by health insurers and, to an increasing extent, the government's taxpayers.

This brings me to the second point illustrated by the airline crash example. If airlines were run like healthcare, they would not only crash two full 747s every three days each year, they would do so while bankrupting their customers. Patients being killed at an alarming rate by the healthcare system, and we are paying an exorbitant amount for it. Not only is the system deadly and expensive, it is archaic, fragmented, and inefficient. While looking up background information and support for this paper, I came across a video, comparing air travel to health care. The following excerpt perfectly sums up how I feel: "This system is insane. It's fragmented to the point of incoherence, record keeping is stuck in the 1960's, communication is stuck the 1980's, none of the systems talks to the others, everyone reinvents the wheel at every stage of the process, there's no pricing transparency..." (The New Altons, 2013, 5:13).

I still do not know how to change the healthcare system, but I do have ideas. The use of technology to its fullest potential can reduce iatrogenic events. I hope to help eliminate the current system wherein multiple stakeholders inefficiently attempt to meet divergent goals, streamlining the process of achieving performance improvement, regulatory compliance and profitability. These ideas will be detailed in my Master's Thesis. When, or if, they will be implemented, remains to be seen.

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gypsyd8

About gypsyd8

MSN, RN. I am a deist, feminist, libertarian, liberal, professional, progressive

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Specializes in Critical Care, Education.

BRAVO!!!

You've managed to provide a concise but very articulate encapsulation of the most serious problems in US health care. I am encouraged to know that we have future nursing leaders such as yourself to help guide us through this morass..

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Specializes in Regulatory Nurse Specialist, State Government.

Interestingly enough; airline travel remains quite safe with a 97% plus survival rate in regard to an aircraft crash; as demonstrated recently; it was the exact people who are charged with the responsibility of saving people; who actually ran over and killed one of the survivors during the rescue events of a most recent aircraft crash success stories with most of the passengers surviving; however, no tragedy should go un challenged! I recently finished up with a Masters degree; and air travel is exactly what is quoted as being one of the investigated tools (How the cockpit works and communication) among airline crews as being a "fix" for the health care system. I have worked as an RN for multiple years Greater than 7; at many facilities in my state; the confounding factor related to all of the safety issues I have experienced is the leadership and how the facility runs. I have been amazed at how sister hospitals in the same ownership ring can vary so greatly in the approach to patient care; between patient safety; patient acuity and staffing-registered nurses continue to be under fire as hospitals continue to perplex and fool communities into believing that their facility is performing and outperforming the competition by announcing multiple initiatives that are designed to "deceive" the patron for the wrong reasons; attached is the reference to a two part article that I think every RN and hospital worker should be well studied on; and perhaps the more people who read these articles; and the better informed Nursing is on the plight hospitals are taking against nursing; then we will have the realization that Knowledge truly is power!

"Scripting and Rounding: Impact of the Corporate Care Model" Home Study Course.

Okay I tried to link my personal PDF of the articles; I could not do this easily so you will have to look this up at your school library ect..

www.nationalnursesunited.org October 2010, CE home study course Scripting and Rounding Impact of the Corporate Care Model on RN Autonomy and Patient Advocacy Part I and Part II (Two part paper) Second Part came out in November of 2010...

(I am not in support of Labor organizations for nursing in one way or the other) Just a very good article review! Interesting to see the historical content as it unfolds in hospitals around my state and perhaps yours as well....

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Specializes in TELE, CVU, ICU.

thank you

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Specializes in orthopedic/trauma, Informatics, diabetes.

Great article!!!!! We have had many seminars where the presenters use airline analogies almost exclusively

I would like to add the specific problems of pharmaceuticals. With out going into too much detail, the policies in place in for pharmacies and mail order pharmacies are dangerous. I am getting ready to start a BSN program and I think I am going to make this a pet project Don't tell me that if a mistake is made that is NOT my fault, that I have to eat it. What medications cost pharmacies and what they bill are too disparate to really cause a company any harm if they have to "eat" it. Don't tell me you have a policy in place and then be unable to produce such policy in writing. Aren't we taught that is if isn't documented, it didn't happen. No policy in writing: no policy in practice.

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Healthcare industry kill so many people because medications over prescribed, surgeries overdone... Too many people get invasive treatments even those they can be treated conservatively. The reason is greed: the more meds prescribed the more money big pharma and doctors get. You cannot change this system, so pt will continue dying and suffering because of their own ignorance.

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Specializes in OB, HH, ADMIN, IC, ED, QI.

FOLLOW THE MONEY!

We nurses take the blame when medication errors occur, yet we accept and continue to work understaffed! Our employers prefer to think "bad nurse needs to be fired and another one will remedy this problem". Except it evidently doesn't. They also follow the insurance industry's lead by firing nurses who are over 55 years of age, who have been able to avoid giving incorrect medications, because their insurers have elevated premiums unrealistically for them. After all, $1,000/month added to younger employees' premiums is unfeasable. So we have many more less experienced nurses working in hospitals, who are more likely to make med errors.....

As patients, we astutely follow our doctors' orders, giving a correct example of the newly coined word "sheeple". Until my financial world crumbled, I did that, too. However it became necessary to pick which medications I can pay for, and which are not fully necessary. I didn't stop the statin I was on, as it's not expensive compared to my other prescribed meds. Now it seems that decision was " penny-wise and pound foolish". I can hardly walk, due to tendonitis of my ankles caused by that statin and exacerbated by taking cipro for occasional acute bladder infections.

Recently a friend casually told me that almost everyone she knows has problems with their ankles. That was corroberated when I made appointments for physical therapy and to be seen by a podiatrist, whose appointment scheduler mentioned that they were seeing people with far more ankle problems. Now as the medical community functions, that could mean an increased number of surgeries are being done, resulting in greater medical costs which could imply that taking cheap drugs is balancing costs.... Add to that, the need for pain medicine and the profits benefit pharmaceutical companies more.

So one might conclude that greed fuels adjunctive healthcare costs, then "offs" sheeple whose needs for care cost too much. That macabre situation gives greater credibility to the need to overhaul an already outdated system for delivering healthcare. Surely Obamacare's emphasis on disease prevention will mean that less hospital admissions will occur, making nurses' jobs doable and med errors less frequent. However administrators of hospitals will likely believe they're overstaffed and make cuts in positions, even if they have enough in their budgets for a greater number of staff, and the merry-go-round of firings and more med errors will recur, while profits increase.

SO FOLLOW THE MONEY!!

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If you haven't already, you should read "Why Hospitals Should Fly" by John Nance and/or any book by Don Berwick. Also check out the Institute for Healthcare Improvement site (IHI.org). Lots of great tools for quality improvement. Keep up the great work.

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