“Maybe there were a few tweaks here and there, but no transformation has come. Now it's 2010,” Thomas told a packed room assembled for a breakout lecture on transforming care delivery models.
Thomas highlighted the efforts of groups such as the Carnegie Foundation, the Robert Wood Johnson Foundation and the Institute of Medicine, which are urging all nurses to receive four-year baccalaureate degrees at a minimum, instead of the two-year diplomas held by nurses who populate staffing rosters and are assigned to work alongside higher-educated peers with little regard for their different levels of expertise.
Thomas' co-presenter, Donna Herrin-Griffith, past president of AONE and a senior adviser at three-hospital Methodist Le Bonheur Healthcare in Memphis, Tenn., said nurses indeed have a greater role to play to improve patient quality outcomes. But the current structure of the workforce is constraining it.
Herrin-Griffith said a group of nurse researchers and professionals recently found many reasons to support the controversial idea that clinicians who have less than four years' college education ought to be redesignated “patient-care technologists.” This new class of workers should take up the staccato 10-second tasks that are preventing nurses from doing the kinds of larger critical thinking that can improve quality.
“This is really not an option anymore,” Herrin-Griffith said.
However, Leape in his address to the nurse executives hailed nurses as being on the vanguard of the quality improvement efforts, while hospital executives have dithered around with concepts like Lean process improvement, which have “industrialized” the system without regard to care.
“Healthcare has become a production system,” he said. “We think more about nursing ratios than we do about nursing. … I don't think most of us think this is progress.”
Leape said the recently passed reform law holds great promise for quality improvement, particularly by encouraging the development of accountable-care organizations, which hold the power to truly transform patient safety by moving away from fee-for-service medicine, making organizations accountable through time-tested nonpunitive measures, and encouraging care by integrated teams of physicians and nurses working in direct collaboration.
Even if hospital executives adopt the myriad administrative changes urged by the National Quality Forum and more their organizations more accountable and integrated, however, that still leaves the physicians, who 150 years after the scientific validation of germ theory, still balk at basic quality recommendations. “Lay people say, why don't you just wash your hands?” Leape said.
But it's not just hand-washing. Many physicians are resistant to true team-based collaboration, and executives fail to understand how a few degrading or disrespectful actions by doctors can have “an incredible corrosive effect” on worker morale in an entire organization, which then drags down overall quality when every employee of the hospital doesn't feel his or her work is valued.
“I absolutely support everything he's saying,” said Richard Brock, a registered nurse and director of medical/surgical nursing services at Kaiser Permanente's Los Angeles Medical Center, standing for several ovations during Leape's speech. “As long as we're finger-pointing and doctors are at war with the nurses and the pharmacists, et cetera, nobody can really be held accountable.”
Joe Carlson covers not-for-profit hospitals and health systems and human resources issues, including staffing, labor and management. He also covers regional healthcare business news in Florida, Iowa, Minnesota and Wisconsin.