Every time I explore a quality improvement initiative with a hospital for Patient Safety Monitor Journal, I always ask two questions:
- What was your biggest challenge?
- What advice would you give to other hospitals?
Especially as of late, the answers revolve around just culture. Quality directors, nurse managers, patient safety professionals, CNOs all tell me the biggest challenge is staff trust and buy-in; the key to success is involving them in the process. We all know the key to improving is knowing what’s wrong, but unless there’s trust between the organization and the staff, you won’t find out that information.
The most recent AHRQ Culture of Safety survey – Hospital Survey on Patient Safety Culture: 2012 User Comparative Database Report – leads me to believe perhaps the knowledge of how to improve culture and safety is there, but it’s not yet in practice to the fullest extent.
This is a big survey, including data from more than a half million healthcare staff from more than 1,000 hospitals, and deserves a good look:
Teamwork within a unit was strong; 80% of respondents agreed or strongly agreed to that sentiment. Generally, staff felt that management supported them and a culture of safety, and that the organization was including systems meant to support staff and reduce errors. To me this says that the talk is there: Staff members are aware that managers and leadership care about safety, and those systems should support them, not hinder them. Seventy-five percent say that management’s actions show dedication to patient safety; 72% believe the systems are in place to prevent mistakes.
Yet when it comes to reporting or speaking up, staff are still wary. Only 62% felt there was communication openness in their organization, and the lowest scoring domain was nonpunitive response to error, with only 44% positive response to questions related to the subject.
When it gets more specific – and more personal–the rates drop lower. Most interestingly is the difference between these two questions:
- Staff will freely speak up if they see something that may negatively affect patient care: 75% agree/strongly agree
- Staff feel free to question the decisions or actions of those with more authority: 47% agree/strongly agree
To whom staff must speak their concerns seems to be a critical indicator as to whether they actually will. This is certainly an issue with culture. The vast majority of respondents (76%) had direct patient involvement, and 35% were nurses. Considering disparate levels of authority create the team responsible patient care, I find this low response to that particular question quite concerning.
Also noteworthy: exactly half believed mistakes are held against them. It’s no wonder the survey indicates vast under-reporting of adverse events, a claim supported by the recent report by the inspector general of the Department of Health and Human Services.
I think the next step for hospitals is to find out what it will take for staff to trust hospitals. What will it take to get a nurse to report an adverse event he or she was involved in? Or demand a time out be performed to a surgeon?
Such a large shift in thinking might take time, as we all know in decades past healthcare has been notoriously punitive. Still, perhaps we should start by asking our staff what it will take to earn their trust. After all, involving them has been the key to so many other instances of quality improvement success.
First published on Patient Safety Monitor Blog
It’s no secret that nurses and physicians do not always maintain the friendliest interactions, and occasionally nurse-physician relations can become downright hostile. Poor relationships between nurses and physicians can lead to communication issues, increased errors, and a lower quality of patient care. Although both parties might feel as though they are behaving cordially, a recent industry survey by HealthLeaders Media revealed a disconnect between nurses and physicians when asked about disrespect and physician abuse. While 42% of nurse leaders felt that disrespect of nurses was common, only 13% of physicians perceived disrespect as a common occurrence.
Communication issues seem to be the major cause for the disparate perceptions of disrespect toward nurses, according to the survey. For example, physicians who are looking to save time and want to hear only key data tend to interrupt or cut off nurses giving a more detailed report. Physicians often don’t realize their actions may be perceived as rude or disrespectful, according to HealthLeaders Media.
But what about physicians who are intentionally disrespectful of nurses? In his blog post “Listening to nurses is key to being a good doctor,” a physician who writes under the pen-name Doctor Grumpy, MD, asserts that “if you come out of medical school with a chip on your shoulder against nurses, you better lose it fast. Because they will make or break your training, and often know more than you do.” He continues on with an example of a fellow physician who ignored a nurse’s concerns about a patient’s heart, telling her rudely that he had already looked at the EKG. The patient, as it turned out, had developed a heart murmur, and listening to the nurse would have addressed the issue sooner and prevented the physician from being reprimanded. Doctor Grumpy demonstrates that an amiable relationship between nurses and physicians is not only possible, but also beneficial to both parties, and to the quality of care provided in an organization.
How can nurse leaders help improve nurse-physician relations? Communication is a major step in the right direction. Remind your nurses to treat physicians with respect, and encourage them to bring up any concerns about physician behavior. If nurses are uncomfortable directly addressing a disrespectful physician, they should share their concerns and perceptions of physician behavior with you. Communicate with the physician that his or her behavior has been perceived as rude or disrespectful, and take the conversation from there. By raising awareness of how actions and words are perceived by others, you can move toward creating a respectful and productive work environment.
We want to hear from you: have you noticed a lack of respect between nurses and physicians in your organization? Have you taken any steps to address these concerns?
New technology has been steadily working its way into all aspects of daily life, and healthcare is no exception. More organizations are adopting electronic medical record systems and incorporating tablet computers into those systems. Individuals are also bringing technology into their work day, which can have positive and negative effects. Last week we posted about a nursing app that allows nurses to quickly access relevant information, a seemingly useful tool, but there have also been stories of technology distracting physicians and nurses from performing their jobs effectively and safely.
A recent poll on StrategiesforNurseManagers.com asked nurse leaders to weigh in on how often nurses use smartphones and tablet computers to perform their duties. The responses were split almost evenly between nurses who use these technologies on a daily basis (46%) and nurses who never use these technologies for work purposes (44%). Other respondents answered that nurses on their units used technology weekly (6%) or monthly (3%).
How does your organization compare? Do nurses on your unit use smartphones and tablets as part of their jobs? Does your organization have a policy in place to address the growing use of mobile devices in the healthcare setting? Leave us a comment and let us know!
Robert Freeman, a registered nurse at Beth Israel Hospital in New York, designed an mobile app for nurses that includes a database of more than 10,000 medical abbreviations and a news feed specific to the nursing profession, according to the New York Daily News. Freeman said the idea for a nursing app came to him when a colleague could not decipher an abbreviation on a patient’s chart. He indicates that nursing students will benefit the most from using the app as a learning tool, but that it will also improve efficiency and productivity for all nurses by quickly answering queries.
Freeman spent three months researching the information necessary to design “Nurse Net,” his free app. The app includes tools such as the Credentialer, which clarifies the abbreviations for various certifications and credentials used by health professionals, and the Abbreviation Assistant, which interprets abbreviations found on medical charts. “Nurse Net” became available in the Apple Store in November and has been downloaded more than 12,000 times since then.
I wonder how patient safety and quality professionals (yes, you) felt about these kind of apps. Personally, I worry about a nurse who, instead of clarifying an abbreviation (which may be a “do-not-use” abbreviation!) with the physician, consults an app. I would always prefer communication between humans when possible rather than consulting a third source, even if it is a bit of effort. Also, speaking directly with the physician might help avoid future issues with that physician’s notes. Is consulting the app a workaround here? And don’t forget, an app isn’t responsible for being right; it’s not responsible for being updated, and most importantly, isn’t responsible for keeping your patients safe. It’s a product, like anything else, even if it’s free and developed by a nurse with the best of intentions.
Are we teaching the right thing here? Weigh in below.
First published on Patient Safety Monitor Blog
Is being a nurse bad for your health? A new survey indicates that this might be the case, and offers managers an opportunity to help staff be healthier and take care of themselves so they can take better care of patients in return.
The survey of more than 2,100 female nurses, conducted by the University of Maryland’s School of Nursing, revealed that 55% of participants were obese. The study used body mass index (BMI) as the primary measure for obesity. The nurses who participated in the survey indicated factors such as jobs stress, poor sleep habits, and long, irregular work hours as the primary causes for their excess weight.
This study comes among other recent reports that overweight physicians are less likely to advise obese patients about the benefits of dieting and exercising to lose weight and improve their health. A common thread among these studies is that physicians and nurses who are at an unhealthy weight are unable to provide the highest quality of care for patients, because they are not caring for themselves and feel they cannot lead by example.
Kihye Han, author of the University of Maryland study, recommended better scheduling methods to allow nurses to practice good sleep habits, and noted that an increase in the availability of healthy food could also make a positive impact. An experiment conducted by Massachusetts General Hospital found that simply labeling hospital cafeteria items with red, yellow, and green stickers to distinguish healthier choice from less healthy options led to an increase in healthier foods and beverages. Busy nurses and physicians could quickly determine the best foods based on the label.
None of the resources referenced above explores another option for encouraging nurses to make healthier choices: nurse leaders. Nurses who are struggling with getting adequate sleep or maintaining a nutritious diet could benefit from the advice, guidance, and support of not only staff leaders but also other nurses in similar situations. Providing resources and healthier options for staff nurses would not only benefit their overall health, but could also lead to improvements in patient care quality.
We want to hear from you! Have you encountered issues with sleeping and eating habits among your unit’s nurses? Does your facility offer flexible scheduling and more nutritious food options to encourage healthier lifestyles? Let us know in the comments section.