The Scandal of Healthcare: Nurses, Waste & Customer Service

[arthurbaird0]

Twenty years of experience and research reveal two indispensable truths about hospitals and healthcare organizations that can no longer be ignored. First, those institutions neglecting the basic fundamentals of patient care, risk jeopardizing the quality and safety of care they provide. And second, nothing can have a greater short- and long-term impact on the cost of delivering healthcare services than nurses.

For more than 60 years the model of patient care has been changing. Hospital operations--the way work works--generally has fallen short in keeping pace with that change. Technology, protocols, and treatments are just a few of the dramatic shifts in recent years. But in the middle of all that change are nurses. In the middle of all the chaos of ringing bells and flashing lights are nurses. Underneath the hum and buzz of delivering healthcare to patients lie dysfunctional and costly processes, essentially forced onto nurses and their colleagues.

The concept of Team Nursing” was designed and implemented during the early part of the 1950s. This new team-based model included staffing with a charge nurse, two or three Registered Nurses (RNs), along with a Licensed Practical Nurse (LPN) and a Certified Nurse Assistant (CNA) both of whom had less clinical training than an RN. This team was responsible for the care of eight to ten patients. Nursing stations were centralized, including connected supply rooms, linen stations, and equipment. Because patient rooms were arranged around the nursing station, it made sense to localize supplies and services. Likewise, connections to important people and information--patient charts, doctors, pharmacists and phones--were centrally located too, just a few steps from the nurses station.

In the 1970s, a man named Gordon Friesen, an architect and logistics expert, proffered a simple notion: provide the highest quality of care possible for the individual patient at the lowest possible cost to the patient. Friesen's solution was built around the idea that the closer supporting people, equipment, and information were to nurses and their patients, the more efficient and effective nursing would become. The added efficiency would, as the thinking went, lead to better quality of care at continually less cost.

Friesen had landed on one of the few aspects of healthcare that everyone agrees on--patients are best served by having nurses with them in their rooms. Patients, their loved ones, executives, doctors, and nurses themselves all want to have nurses face-to-face with patients as much as possible. Yet, despite this common desire, due to myriad daily system failures, today's nurses are able to spend only a mere fraction of their time in direct contact with patients. Admissions and discharges take up most of this face-to-face time. Generally, patients see their nurses briefly every hour or two, which neither patients nor nurses find satisfactory.

Today the nursing station is all but gone. Medication frequency, dressing changes, and other prescribed care are ordered from a computer located in a patient's room, or just outside the door. In a scenario we have seen repeated hundreds of times, a nurse hurries to get medication, which is nowhere near the patient's room. As the nurse hustles to the med room, her aide asks for help with another patient, which delays the nurse's ability to deliver her original patient's meds. Now already several minutes behind in getting medication, the nurse is assessing another patient who, say, needs supplies too. But unfortunately, those supplies are stocked in a different room from the medication. Leaving to get both, the nurse runs into a family member there to see their loved one. It just so happens to be her patient, and that patient needed their medication seven minutes ago. She provides a quick update and tells the family member they can see their loved one, and that she'll be right back. But then Transport calls. They're running late, which delays a patient's discharge, the one who's still waiting for the medication.

At present, nursing is a decentralized system of continually changing needs. As seen in the preceding paragraph, the failure to connect services to nurses increasingly burdens the daily activities of nursing. The difficulty arises for nurses because while nursing activities are decentralized, supporting services remained centralized. This mismatch in operational processes ensures each nurse will spend time hunting for, fetching, and clarifying what their patients need. This is further complicated by frequent failures in these mismatched processes. It's certainly true nurses need to be available for the patient. But when nurses aren't available, it's primarily due to hospital operations failing to meet the needs of nurses as the principal providers of care to patients.

Consider our proxy for hospitals across the country: AnyWhere in America Hospital (AWH). At AWH, medical equipment is upgraded regularly by contract with vendors in an effort to keep costs low, or to replace older outdated equipment. Usually this new equipment requires specific supporting supplies. A great example is an IV pump--a piece of equipment used all the time at AWH to introduce vital fluids and medications to the body. At AWH, leaders coordinate the new equipment supply needs for the upgraded IV pumps for each participating department during the roll-out phase.

However, many times implementation proceeds faster than expected. Confident in their planning and adaptability, AWH decides to roll the entire project out in record time, ahead of schedule. Unfortunately, Materials Management hasn't been notified of the timeline change and can only support the roll-out plan as originally designed. Nurses in various departments, lacking the proper supporting equipment and documentation, panic--adding tension to an already stressful job. Urgent calls begin as nurses from several departments, frustrated by the new equipment's impact, request large quantities of supplies that Materials doesn't have. The sudden flurry of ordering hits the Materials Supply Department, which then overcompensates by over-ordering, then overstocking. The overstocking causes both storage and delivery issues as problems begin to ripple outward.

The reality here is that healthcare organizations/hospitals (HCOs) function in a manner that requires nurses to focus more of their limited time and attention diagnosing systems needs than patient needs. Nurses scrambling for linen, supplies, equipment, or waiting to clarify a medication prescription are just a few examples. These types of process failures and hundreds more like them, happen thousands of times every day in every hospital across the United States. Sometimes these impacts affect the patient--leaving nurses stuck caring for patients in a system that's failing them, or at least making it tremendously difficult to manage the operational chaos, rather than being able to maintain the health and recovery of their patients.

There is a serious scandal in healthcare: the toll that healthcare takes on the people who deliver it. The burdens of regulation, cost reductions, and quality initiatives piled onto nurses and other clinicians are undeniable. Without real operational gains and improvements, nurses will continue to be inundated with yet more of the same, and its impact will be evermore noticeable. When things go wrong operationally, it's the nurse who feels the pain first, leading to less-than-optimal care for their patients.

[Lev, MSN, RN, NP]

I worked for a hospital which had supply closets and a computer outside of each room with some of the patient's meds in a drawer outside of each room and prided themselves on the fact that the hospital was designed so nurses could spend more time with their patients. I still looked for supplies. Why? Because people didn't stock well, pharmacy sometimes didn't put all the right meds in the drawer, some meds were from the pyxis and sometimes it was hard to know which med was standard to the pyxis because they were uncommon meds which you didn't think would be stocked regularly. Also, there are supplies like bedside commodes, IV pumps, IV fluids, and scd machines which require a lot of storage space and could therefore not fit outside of the room. I like the idea of a central nurses station and supply room. More chances to chart undisturbed. Hospital looks neater too.

[rnsrgr8t]

Interesting article. What they need to do is let the nurses staffing the unit, design the unit. I once worked on a floor that was recently sponsored by a large company. They totally gutted the floor and the staff were able to redesign what they wanted without cost being a factor. It was the best laid out floor I have ever seen. They had their own pharmacy on the floor. It was a hem/onc floor so the outpatient specialty clinic was on the same floor as the inpatient unit (easy to get admissions from clinic when needed). There was a centralized nurses station that was open and designed like a big circle. There were three halls of patient rooms off of the circle. The rooms for the more acutely ill patients (with monitors etc) where on the periphery of the nurses station so you only had to walk 5 steps to get to any of these patients. Our med room was at the center of the unit as was our supply room. Each patient room had a cabinet that you could access in or outside of the room that stocked all your supplies and linens. It was kept stocked. The staff designed the cabinet, what they wanted in it, how to label stock it etc. It was an amazing unit.

The hospital I work out now recently built a new inpatient tower. all new inpatient rooms. They did not ask for any real input from the staff (they said they did but not really). It is beautiful and the families love it. Guess what, staff HATE it because it does not flow at all and everything is too spread part.

It is the same ol same ol.... they never want to ask the people that have to use the space every day what would work well for them. They suits think they know what is best when they often have no medical background.

[arthurbaird0]

Please Read The Scandal of Healthcare: Nurses, Waste & Customer Service. If you are a nurse, love a nurse or know a nurse.... They are Hero's.. Without them I am not sure I'd be here. They took care of me when I really needed help. I hope ALL nurses know just how crucial they are.

[Lev, MSN, RN, NP]

We do know how crucial we are. Hospital administrators do not.

[arthurbaird0]

I believe that ALL hospital administrators, managers, directors, VP's and hospital presidents should read. The Scandal of Healthcare: Nurses, Waste & Customer Service. As one reader wrote "This book is as true as it gets.It is not for the nurses, they live it. It is for the Leaders and Managers that create those internal processes that the nurses work in" Another wrote, " I enjoyed this book for a couple reasons, it showed me why I left bedside nursing - and it is a great step to assist healthcare decision makers understand, or get a glimpse of what is going on - and why their decisions are so important."

And thank YOU for taking on the arduous job of nursing.. You are a Hero to me!

Best Regards

[Lev, MSN, RN, NP]

This website is not supposed to be used for promotion of goods/materials per terms of service.

[APRN., DNP, RN, APRN, NP]

[quote=Lev

?! ?

I am missing where this post advertised for any goods or services.

Is it just me?

[Lev, MSN, RN, NP]

Amazon.com: The Scandal of Healthcare:: Nurses, Waste & Customer Service eBook: Colin Baird, David Sundahl, Adirondack Editing: Kindle Store

One of the author's of the book is Colin Baird. The OPs name is arthurbaird0. He may be the "author" of this book or related to the book's author.

[NurseGirl525, ASN, RN]

This is a nursing student section. Not general nurses and I do believe you are trying to promote your agenda here.

[APRN., DNP, RN, APRN, NP]

Just so you know ~ a lot of folks just scroll past a thread in the "what's new" section.

That's what I did to wind up here.

I certainly don't go to the students section and hang out.

I saw the title, read the OP, and thought it was insightful.

[arthurbaird0]

Where's the best place to post articles?