What struck me is that only one person (the nurse) was named in this case as a contender for advocating for the patient. If Deming's framework developed in Japan was properly utilized in this hospital they would have had to have an accountability structure at every level. I saw in another posting a lot of pretty acronyms that I understand but would a normal Sam or Jane know where to go to get help? Help should be from who you ask and they should have the ability (and obligation) to follow it through.
I went through the TORTURE of nursing school and a few years of hospital training. I could tell you a lot of what’s wrong? Nursing for one is not treated as a profession, it’s an occupation. No other types of executive professionals have to 'clock in'. There is a decided lack of teamwork, rampant nepotism, egocentric personalities and the thought that the client is a number rather than their own mother or brother. We all have to approach patient care with a 'teamwork' mentality which is rather difficult for many to adjust to in this society.
We should all be thankful we have the opportunity to work hard and provide beneficence to our clients (patients). Look to the head of your hospital as to what is wrong. A team is only as good as their leader and a weak foundation makes for poor outcomes. Priority must be in QUALITY not hours worked nor volume of services, nor should it be bed utilization. Quality does count!
I find in my own research and presentations that many across the U.S. are indeed sincerely interested in quality of care but have been routinely stagnated by prior policies or stringent polices provided by their governing boards. Would I advocate socialized medicine… well that’s a resounding NO!!! I have personally gone to Russia and investigated other societies. We are indeed lucky but that doesn’t mean we can’t set international standards rather than concur with egregious behaviorisms.
A few suggestions:
Ø Quit hiring nurses to be universal managers of everything in a hospital; they are NOT business people they are caring and loving nurses and generally lack the training or skills needed to initiate overall managerial changes without further managerial training. I have personally viewed some exceptional nurses who were wonderful patinent care advocates who were exceptionally inept mangers unbeknownst to the hosptial's adminstration. I could go on for entire book on this one! I did a cost analysis at a hosptial when I was a student nurse and the hospital could have saved 8 K a month for just making a simple clean/dirty room change. They don't connect the dots routinely and this is NOT their fault.
Ø Hire more outside consultants with limited time access.
Ø Strive for higher levels of ethicism and realize that sexism, ageism, nepotism and the like are going on at your facility. A blind eye to this does not make it go away.
Ø Quit treating nurses and tertiary staff like dogs. I’ve been in the trenches and believe me it’s gross. Example: on an average night of a level one trauma hospital ~ 6 patients with two of them at a high level of acuity and an average of 15 medications apiece does not make for good patient care. Burnout, rage and despair are the name of the game.
Ø Cross-train staff as frequently as possible and constrain hours worked the same way airline pilots now manage their time.
Ø Have night-time staff support, I wonder how many CEO’s try to eat at 1300 hours? Management works days but it appears to me that there are still a lot of patients in the hospitals at night? Do you really know what goes on?
Ø Treat your staff like gold and they will provide you wealth… words to live by.