Category Archives: Patient safety and outcomes
Michael D. Cohen, PhD, is the recipient of a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research, and the William D. Hamilton Professor of Complex Systems, Information and Public Policy at the University of Michigan School of Information.
Handoffs are a critical link in maintaining continuity of care during a hospital stay. Whenever there is a shift change, or when a patient moves between departments (such as from an Emergency Room to an inpatient unit), there should be communication between the personnel who have been caring for the patient, and those who are to assume responsibility. These handoffs have to be done effectively. Root cause analyses of sentinel events find communication breakdowns to be major contributing factors nearly two-thirds of the time, and a large fraction of those problems occur during handoffs.
It seems logical that nurses and doctors should receive some training in how to conduct these vital conversations, but in interviews during my research on handoffs, it has been rare to find a practitioner who learned anything in nursing or medical school about how to hand off effectively.
The Robert Wood Johnson Foundation (RWJF) Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? This post is by RWJF Investigator Award in Health Policy Research recipients Robert L. Wears, MD, PhD, a professor in the Department of Emergency Medicine at the University of Florida, and Kathleen M. Sutcliffe, PhD, The Gilbert and Ruth Whitaker Professor of Business Administration at the University of Michigan’s Ross School of Business.
There are many aspects to the problem of what is or is not working in health professionals’ education today, and the changes needed to address them. From our view as researchers studying issues of safety, resilience, and managing for the unexpected, some of the more important are that health professionals’ education is seriously deficient in the social sciences; is limited almost exclusively to largely positivist ideas about what counts as scientific activity; and is almost totally devoid of the humanities.
None of these deficiencies are new, and that is what concerns us. The lack of engagement with the sciences of safety, and of human and organizational performance, has implications for practice, for safety, and for understanding and creating actionable knowledge.
With respect to practice, for example, without sufficient exposure to humanities and social sciences we risk socializing people to become authoritative but inhuman techno-nerds, even if they didn’t start out that way.
With respect to safety, we risk training people in positivistic methods and research approaches that oversimplify and even miss local contextual specifics that create real threats to safety.
With respect to understanding and knowledge creation, we risk training people to revere scientific and technical rationality and ‘objectivity’ at the expense or even denial of any sort of constructivist or interpretive understanding.
Linda Cronenwett, PhD, RN, FAAN, is the Beerstecher-Blackwell Professor and former dean, School of Nursing, University of North Carolina at Chapel Hill. Since its creation in 2005, she has led the Robert Wood Johnson Foundation (RWJF) Quality and Safety Education for Nurses (QSEN) project at the University of North Carolina at Chapel Hill.
In Tucson last week, more than 400 educators from nursing education and practice settings celebrated a transition in leadership for the Quality and Safety Education for Nurses (QSEN) website and National Forum. As of August 2012, support for these important resources will transfer from the University of North Carolina at Chapel Hill to Case Western Reserve University’s (CWRU) Frances Payne Bolton School of Nursing.
Seven years ago, a small committed group of people began work aimed at altering nursing professional identity formation so that a new type of nursing school graduate would be developed—someone who would come into the workforce with the knowledge and skills necessary to both deliver excellent care to individuals and continuously improve the health care systems in which they work. We worked hard to build the will to change, generate ideas about how to develop each of six quality and safety competencies, and support execution through changes in accreditation of programs. And just before our third QSEN National Forum, publishers Wiley-Blackwell released the new book, Quality and Safety in Nursing, edited by Gwen Sherwood, PhD, RN, FAAN, and Jane Barnsteiner, PhD, RN, FAAN.
Happy National Nurses Week! The Robert Wood Johnson Foundation (RWJF) has a proud history of supporting nurses and nurse leadership, so this week, the RWJF Human Capital Blog is featuring posts by nurses, including leaders from some of our nursing programs. This post is by Mary Naylor, PhD, RN, FAAN, director of the RWJF Interdisciplinary Nursing Quality Research Initiative program and the Marian S. Ware Professor in Gerontology at the University of Pennsylvania School of Nursing.
Nurses—the largest group of health professionals in the country—have a tremendous impact on health and health care. But despite the immense size and influence of the nursing workforce, we don’t know enough about how nurses can improve the quality and safety of care and reduce costs.
Nurse scientists have been exploring these questions for decades, but large gaps in knowledge remain. Since it was established in 2005, the Interdisciplinary Nursing Quality Research Initiative (INQRI), funded by RWJF, has worked to address those gaps in our knowledge of nursing care.
Over the last seven years, INQRI grantees—teams of nurse scientists and scholars from other disciplines—have conducted groundbreaking research focused on the ways in which nurses affect the quality of care patients receive and how they improve patient care and outcomes.
The interdisciplinary nature of the project has been key to its success; when scholars from multiple disciplines come together to solve problems in nursing care, they generate solutions that are grounded in rigorous evidence, that take into account diverse perspectives, and that use various methodological techniques. In short, interdisciplinary research leads to more robust findings. And more robust findings are more likely to attract investments in nursing resources, which will, in turn, improve health outcomes while reducing costs.
As program leaders, we don’t just talk the interdisciplinary talk; we walk it too.
Ten years ago, the Institute of Medicine (IOM) issued Crossing the Quality Chasm, a landmark report calling for major quality and safety improvements in the nation’s health care system. It came on the heels of the IOM’s 1999 To Err Is Human Report, which estimated that there are 44,000 to 98,000 error-induced hospital deaths each year. That report made an urgent and compelling case that improvement was needed.
In the years since, quality and safety have been top-of-the-agenda priorities for researchers, clinicians and policy-makers alike. With funding from the Robert Wood Johnson Foundation (RWJF), this April’s issue of Health Affairs takes a look at where things stand today, assessing a decade’s worth of progress toward safer, more effective, patient-centered health care. In a series of articles, several by RWJF scholars and alumni, the issue examines a range of related topics supporting the theme of the issue, “still crossing the quality chasm.” In an overview, Editor-in-Chief Susan Dentzer writes,
As a number of articles in the issue demonstrate, there’s no doubt we’ve made progress—but it’s also clear that making any headway has been agonizingly slow. If ever the state of high-quality health care appeared to be an achievable end point, we recognize now that—to paraphrase Ralph Waldo Emerson—quality, like life, is not a destination but a journey.
Physician Faculty Scholar Studies Compliance with Illinois Law Requiring Prompt Transport of Trauma Patients
Marie Crandall, M.D., M.P.H., RWJF Physician Faculty Scholar (2008-2011), has an article in the December 2010 Archives of Surgery, in which she reports findings from her research into whether seriously injured trauma patients in Illinois are being transported to the care they need within a legally required two-hour period. Crandall and colleagues find that while just 20 percent of patients were transported within the required time period, the most seriously ill of the trauma patients were identified and transported rapidly. They also find no adverse effect on outcomes for patients whose transfer time exceeded two hours.