Improving patient safety and satisfaction can start with improving the job satisfaction of hospital staff, according to quality experts addressing a conference in late September in Chicago sponsored by Joint Commission Resources and the American Medical Association.
The experts often took a blunt approach in identifying what needs to be done and what actually is being done to improve healthcare quality. Their themes included building cultures where quality and excellence are encouraged and acknowledging that people will always make mistakes, so systems need to be in place to prevent errors from harming patients. They said the strategies to improve teamwork and the quality of care include using simulators and reviewing errors or difficult cases as soon as possible while people still have details fresh in their minds.
For the strategies to work, speakers said, everyone on a hospital staff has to feel he or she can make a difference-and this requires replacing medicine's traditional hierarchical culture with one in which everyone feels empowered to help solve problems. "Culture eats strategy for lunch," said Henry Russell, M.D., vice president for clinical affairs at VHA Central Atlantic, Charlotte, N.C., who added that just developing "motherhood and apple pie" value statements do little to change an organization's culture.
Paul Uhlig, M.D., associate chief of staff for clinical improvement at Cincinnati's University Hospital, noted how that kind of attitude is common in institutions where a nurse may believe "Good teamwork means I'm asked for my input," but the physician's perspective is "Good teamwork means they do what I say."
Richard Shannon, M.D., medical director at Allegheny General Hospital in Pittsburgh and a member of the Pittsburgh Regional Healthcare Initiative's executive committee, talked about how statistics can lull a staff into complacency. Data are collected to be reported but not acted on, Shannon said, creating an illusion that there are acceptable numbers for errors and preventable deaths. When a facility's statistics fall within "normal" levels, he said some organizations become convinced they are high performers but they're really only the best of the worst.