From the Editor’s Perspective … .
Article Outline
Cindy Lewis, MSN, RN
AS I LOOK BACK through this past year’s Journal issues, it is apparent that we have been able to share with our readers the many new advances in technology, best practices, and improvement initiatives. Changes in health care and improvements in the way we practice have become the norm. Certainly our health care systems are challenging and complex. We all are being asked to make successful and effective changes within our practices, but it is also clear that change in complex systems is difficult.
As health care professionals who desire to create safer health care systems we may have little familiarity with what is known about making change successfully, ensuring that it is an improvement, and having it endure. Professional knowledge such as basic and clinical science, interpersonal skills, and values are critically important but may not be sufficient when the task at hand involves a complex system. Professional knowledge regarding best practice needs to be complemented with knowledge regarding principles, processes, and methods for improvement. Ask yourself “how can we make it happen consistently for patients?” At the core of this question is the use of evidence to identify changes, plan a test, and assess the results.
We are all faced with trying to improve patient care yet maintain efficiencies and productivity. Ensuring patient safety is just one example, yet one critical element in improving the quality of care. Preventing medical errors and improving patient safety are top priorities within our health care organizations and requirements of many regulatory agencies. One hospital found that it took 60 steps to administer a routine medication to a newly admitted patient.1 Each of us may deal with our own system processes that are cumbersome, not user friendly, and ultimately can negatively affect patient safety.
In an initiative sponsored by the Institute for Healthcare Improvement, 36 hospitals collaborated in their efforts to reduce medication error.2 They found a combination of interdisciplinary teamwork, rapid cycle improvement methods, and human factor principles for reducing error led to improvement in a substantial portion of change attempts. Successful efforts to change systems and prevent error tended to have the following characteristics:
Interventions that failed included those that were limited to education, information dissemination, and rule changes.2 Although these strategies are powerful, they rely on telling people what to do, rather than changing the system to make it easy to do things right … or impossible to do them wrong. Ensuring the successful characteristics can help you outline your processes for successful change.
Central to the concept of improvement principles are ensuring the stakeholders are involved and part of the planned change. Our patients are our major stakeholders in changing how we practice. We must partner with our patients to help them manage their conditions. The literature demonstrates that to improve quality and provide more patient-centered care we must be proactive and inclusive, and customize our care to the individual patient. To make it more collaborative, we must use a team approach to share information among health care workers and patients alike.
Our Journal can provide the avenue for each of you to share your planned change processes. As we prepare for the New Year ahead, I would ask each of you to review what new practices, innovations, and/or protocols have you incorporated into your nursing care? What new system processes have you improved? Share with us your practice changes. Share with us the work you are doing within your interdisciplinary teams to improve the delivery of your care. Only through sharing our knowledge and skills can we successfully impact patient care. “Learning is most easily accomplished when lessons can be placed in a context and opportunities exist to apply the lessons learned. Without this chance, lessons learned are soon forgotten.”3 Share with us your lessons learned!
References
- . Making medication safety a strategic organizational priority. Jt Comm J Qual Patient Saf. 2000;26:341–348
- Reducing adverse drug events: lessons from a breakthrough collaborative. Jt Comm J Qual Patient Saf. 2000;26:321–331
- . What faculty need to learn about improvement and how to teach it to others. J Interprof Care. 2000;14:147–159
PII: S1062-0303(06)00117-8
doi:10.1016/j.jvn.2006.09.002
© 2006 Society for Vascular Nursing, Inc. Published by Elsevier Inc All rights reserved.
