Despite the focus on bedside safety, I don’t believe a next major improvement in healthcare will happen with another National Patient Safety Goal. As insightful as they are, they are missing the larger picture – and one to which each of us no doubt can relate. Rather, the next big improvement will result from a comprehensive integration and alignment of operations within and across the healthcare organization – proving that alas Structure does indeed lead to Process which influences Outcome. (Thank you Avedis Donabedian). Thankfully, such operational excellence is possible today – no, yesterday.
The challenge in healthcare is the much broader and deeper structural barriers. This explains the multiple attempts to improve processes and outcomes that fail after months of hard work. Creating and maintaining sustainable improvement often succumbs within the bureaucracy of the organization. The organizational structure seems to be designed to inhibit change in favor of the status quo. Therefore, the greater need for improvement is not with process and outcomes, but with structure.
For example, lasting solutions must include considerations beyond policy revisions and staff education/training. Improvement also requires application to disparate system-wide concerns – such as job descriptions and annual evaluations, supporting documents, job tools, just in time resources, bedside medical record documentation and EMR changes, awareness of patients, physicians, managers, families, public, governing board – and building itself into a culture of high(er) reliability. In other words, improvement requires a cohesive and supportive structure.
A cure is found in consistently integrating and aligning those standards, policies, education, forms, consents, job descriptions, handbooks, patient education, websites, rules & regs, etc. Making sure staff have access to ONLY the latest and comprehensively aligned version to provide a consistent message to all staff – all the time. A change in a standard triggers the need to review and /or revise the associated tools to keep everything current and compliant.
Maybe then we will be able to make some significant, lasting improvement to process and outcome.
It is possible to do this today? Yes. Would it benefit patients and staff? Yes. Would it help bring some harmony to the mayhem? Yes. Is there any good reason not to do it now? Absolutely not.