Nurses lead the way in pa­tient-safety im­prove­ment

Grow­ing num­ber of pa­tient-safety and qual­ity-im­prove­ment ini­tia­tives at hos­pi­tals are be­ing spear­headed by nurse lead­ers

Modern Healthcare - - Front Page -

In 2003, nurses at 121-bed Se­ton North­west Hos­pi­tal in Austin, Texas, be­gan par­tic­i­pat­ing as a pi­lot site on a Robert Wood John­son Foun­da­tion-funded ini­tia­tive called Trans­form­ing Care at the Bed­side. The project’s aim was to use nurses’ ex­per­tise to im­prove the qual­ity of care in hos­pi­tals.

Over the course of the next sev­eral years, nurse lead­ers at Se­ton North­west de­vel­oped more than 120 im­prove­ment ini­tia­tives in four main ar­eas: safety and re­li­a­bil­ity; pa­tient-cen­tered­ness; waste re­duc­tion; and teamwork and staff vi­tal­ity.

To date, the nurse-led project has been rolled out in 30 units and has spurred im­prove­ments in fall re­duc­tion, pa­tient dis­charges, care continuity, ef­fi­ciency and many other ar­eas, says Mary Viney, vice pres­i­dent of nurs­ing sys­tems and net­work ac­cred­i­ta­tion at the Austin-based Se­ton Fam­ily of Hos­pi­tals, the par­ent or­ga­ni­za­tion of Se­ton North­west.

“It’s so im­por­tant to have nurses in these lead­er­ship roles in qual­ity im­prove­ment,” Viney says. “They have the in­ti­mate knowl­edge of what works and what doesn’t.” In the early stages of the ini­tia­tive, nurses at the hos­pi­tal wor­ried that com­mu­ni­cat­ing and col­lab­o­rat­ing with physi­cians might prove dif­fi­cult, Viney says, but they found out quickly that such fears were un­founded.

“We thought nurse-physi­cian col­lab­o­ra­tion would be a much big­ger ob­sta­cle than it ac­tu­ally was,” she says. “Physi­cians were glad to work with us and more than will­ing to take our lead and lis­ten to our ideas. It was by no means easy, but many of the be­liefs we had about our cul­ture were changed pretty quickly.”

For in­stance, one nurse chose to de­sign a for­mal process for use in round­ing with physi­cians. She part­nered with a physi­cian, and the two worked to­gether to de­velop stan­dard­ized ques­tions nurses would ask dur­ing rounds, in­clud­ing ones re­lated to dis­charge plans, pa­tient ques­tions and test re­sults from the pre­vi­ous day.

“We did ex­pe­ri­ence some push­back from that project, but the beauty was we al­ready had a physi­cian on board and be­cause it was only one nurse and one physi­cian work­ing to­gether, they could iron out de­tails and ad­dress con­cerns be­fore rolling it out to the whole unit,” Viney says. “This ini­tia­tive opened those lines of com­mu­ni­ca­tion and helped physi­cians and nurses raise is­sues that they were concerned about.”

That in­ter­dis­ci­pli­nary ap­proach is crit­i­cal to cre­at­ing a cul­ture of safety, es­pe­cially as nurses in­creas­ingly as­sume more lead­er­ship roles within qual­ity im­prove­ment, says Pat Fol­carelli, di­rec­tor of pa­tient safety at 621-bed Beth Is­rael Dea­coness Med­i­cal Cen­ter, Bos­ton.

Fol­carelli, who is a nurse, says that al­though Beth Is­rael Dea­coness stresses the im­por­tance of nurse lead­er­ship, their suc­cess comes from in­cor­po­rat­ing physi­cians, so­cial work­ers, phar­ma­cists and other front­line staff in all of their im­prove­ment ini­tia­tives.

“Our or­ga­ni­za­tion is fairly pro­gres­sive in terms of hav­ing all voices in­cluded, as op­posed to a more siloed sys­tem, and I think it would be very

Mau­reen McKin­ney

Val­ley Hos­pi­tal in Ridge­wood, N.J., has im­ple­mented the Just Cul­ture

pro­gram, a col­lab­o­ra­tive, non­puni­tive ef­fort that en­cour­ages staff mem­bers to speak up when they see prob­lems that

need at­ten­tion.

Viney: Nurses know what works and what doesn’t work.

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