Tuesday, December 16, 2008

There is no wizard........

No, Dorothy, there is no wizard. We can't click our heels together and make patient care safer, and we can't click our heels together to balance the budget. Patient Safety, Quality Improvement, and all Financial Stewardship require hard work....every day.

I bundle these together for many reasons.

First, they are indeed intricately connected. We know that unsafe, ineffective, inefficient, or poorly timed care is not just bad care, it is wasteful care. Many of us grew up in the era where we were constantly told that more care = better care. We know better now. Better care = better care, and better care is often less care, especially if the "more care" comes from trying to get it right a second time.

Second, I recently was at IHI where Dr. Berwick eloquently talked about the two choices we all have...to fight to continue to make care safer over the next twenty years, or to give up because it is too hard and because the returns on our hard work and emotional committment are often too elusive. And then I returned to Contra Costa and California where we are faced with astronomical budget deficits. We will need to answer Dr. Berwick's question within this economic context.

So what's my answer? Giving up is not an option. We will work together to continue to improve the quality of the care we give. It will not be easy, and there will be tough choices, but giving up is not one of them.

And clicking our ruby slippers is not an option either.


  1. I couldn't agree more with Steve. We at the safety net are with you. I am with you. Giving up is not an option. We have to press forward and fight for every inch of improvement in quality and making health care delivery safer. It is not easy, it has never been easy. But the more we engage and engage others in improvement, the easier it will become to tackle that next difficult task. Not because that next task is innately easier to accomplish than the ones before. But because our ability, skills and thinking have been refined and improved to rise to the challenge. Adelante!

  2. Hi Anna,
    Unfortunately I was unable to locate my response to your blog and was unable to forward.
    Your current blog is a very compelling story. I agree that sometimes there is more efficiency with simplicity. Too many changes seem to shift attitudes in the opposite direction anticipated. Our preparation, presentation and delivery for change agents can make the difference in a joint effort (seamless as you would phrase it) vs disconnected and fragmented. Healthcare has so many challenges throughout the system, nursing alone has so many dimensions including nurses that walk thru the door with different levels of experience.There are staff, registry, and travelers that have so many changes from hospital to hospital since so many nurses moonlight elsewhere.

    It is critical to standardize hospital practices so there would be less room for error.
    Additionally although so many people would not agree there should be a limit to work hours per day and if exceeded there should be a mandatory time off with no other work anywhere. Thats what the railroads and airline industries mandate for safety purposes. Why would doctors,nurses and other staff be any different?Of course the liklihood of errors increases as we become more tired,fatigued and exhausted only to return in a few hours to our next shift here or at another hospital. It seems reasonable to demand rest of at least 8 hours rest after a double shift in a 40 hour workweek. There should be a limit with other incentives built in. We need to consider those impacts at the bedside.

    Change begins with our attitudes and we all need to do our part for the team. Together we can make effective positives strides in healthcare. I am encouraged by the forthcoming efforts for safe care at the bedside. Our measurements and evidence based practices are part of the solution for tracking and improving care at the bedside. There are additional areas that will not be better served by statistics and evidence based practice. The gut goes a long way too. There are times that safety can be accomplished with the basics rather than all the bells and whistles.

    We need to layer our change system agents differently so we are not blockaded by process that are haulted due to lack of communication between the layers. Conversely there have been changes rolled out before checking with all areas affected only to rewrite a new policy or procedure. Sometimes too many cooks spoil the brew.

    Adequete representation from all areas needs to be involved but not overwieghted.

    Sonia L. Foster, BSN, RN