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