Medical Errors Report #9
A Four-Year Solution Implementation Study
Workload Forces Employees to Take Shortcuts, and Compromising Quality of Care
Increase in Workload Forces Employees to Take Shortcuts, and Compromising Quality of Care
Increasing workload, lacking time to evaluate details of a procedure, rushing to do the work, taking short cuts and being pressed by physicians and hospitals to save time continue to create a sizeable number of medical errors in hospitals every day. Many nurses, pharmacists and other health-care workers indicate they have been pushed to the limit of their endurance, and many are quitting hospitals. They claim the hospital administration is not listening to their concerns. Can medical errors be fixed in this type of atmosphere? Can this type of situation foster effective solution implementation?
In 2002, State
Senator Allyson Y. Schwartz introduced in Harrisburg, P.A., a bill, Legislation
Introduced to Set Minimum Nurse-to Patient Ratios in Pennsylvania Hospitals, (PR
Newswire, June 18, 2002). The bill makes it mandatory for licensed facilities to
develop and publish a staffing plan that meets minimum nurse-patient ratios. In the
article, Marilyn Hostetter, coordinator of staffing in one of the hospitals, indicates
that while there is no shortage of nurses in the state, there is a shortage of nurses
willing to work in hospitals. She cited the study done by a different organization where
76 percent of the Pennsylvania nurses indicate their units lack adequate staffing.
In 2002, State Senator Allyson Y. Schwartz introduced in Harrisburg, P.A., a bill, Legislation Introduced to Set Minimum Nurse-to Patient Ratios in Pennsylvania Hospitals, (PR Newswire, June 18, 2002). The bill makes it mandatory for licensed facilities to develop and publish a staffing plan that meets minimum nurse-patient ratios. In the article, Marilyn Hostetter, coordinator of staffing in one of the hospitals, indicates that while there is no shortage of nurses in the state, there is a shortage of nurses willing to work in hospitals. She cited the study done by a different organization where 76 percent of the Pennsylvania nurses indicate their units lack adequate staffing.
Workable Quality Improvement Must be Initiated and Supported by Upper Management
It cannot be overstressed that if the hospital upper management does not initiate and empower the process of fixing medical errors (or fixing systemic failure in any business), nothing will happen. The power-house of control in fixing the process is in every administration. Some administrations created problem-solving committees, giving each of them a problem to solve. They expect the committees to come up with solutions within a year. This is a fallacy! A committee needs more than just committee members. Resources, equipment, manpower, and money needed for the successful operation of a committee should be preplanned depending on the size of the project. Team leaders and facilitators need special training. Without resources and empowerment a project can drag on for many years, making little or no progress. In such a situation progress attained may be small compared to efforts, and the project may failed to achieve its objective. Fixing medical errors and systemic failures takes a lot of work and time. If the institution is unwilling to allocate resources for such a project, the initiative is doomed to failure.
Part of the major obstacle during this study was to convince some hospital executives to change their operational style. Some of them believe as long as they are doing what other hospitals are doing, problems will be solved. One example is that a hospital executive, being a nurse and in-charge of the laboratory only comes to the department once in a while to conduct meetings. She tries to present a pleasant image of herself during these meetings. Unfortunately, employees are not interested in her attempt to sell herself as a nice person as much as they are interested in her interaction with them. Workers want to talk to her about the problems. But, she was still using the old system of hierarchy of communication where the upper management talked only to the head of the department and the rest of the employees were insignificant. However, without conducting regular meetings with employees to find out what was happening she ended up with a very poor reputation among lab workers. A nice smile does not make anybody a good manager. Based on interviews with lab employees in this institution, a hospital administrator made a major mistake for selecting a former head of the hell-raisers as a director over the laboratory. How can such a former trouble-maker motivate other lab employees and gain their trust? I lost my respect for the administration for selecting such a person to head this laboratory, said one of the laboratory employees. Hospital executives make this type of selection mistake due to their detachment from the employees working on the frontline.
Martin C. Norwak article, Nowak: Success Depends on Commitment to Enhance Quality, Staffing Morale, (Healthcare Finance Management, March 2002) describes one of the most successful hospital executives in the nation. He is the executive director and CEO for the University of Alabama, at Birmingham Hospital. In the interview, he indicates that it is very important to retain the best people at every level of the organization. One of the areas of his success besides the financial success of the hospital is his connection to employees. He breaks down the hierarchy of administrative communication and replaces it with an open door policy in which any employee can talk to him. He conducts breakfast once every month with 20 employees to hear their complaints and finds out what is working. Town-hall meetings are also conducted from time to time. One of his major measurements is the patient-satisfaction survey. He also stresses the importance of attracting and retaining the best workers to do the job. But, he cautions that it is difficult to foster good morale and create an environment where employees want to work while maintaining financial success of the institution. His slogan, given to him by his father: Hire the best and manage with compassion.