Working with many hospitals as I have, I realize that I am in a unique position to be able to see the inner workings of the hospital, as well as its relation to the greater market of hospitals without the pressures of having to compete, manage or work there.
I was recently speaking to a nurse who explained to me that, most days, she was overwhelmed with tasks during her shift and could not get them all accomplished. For every clinical intervention, there was a flow sheet, and a checklist, and a report, and some need to document on the commodore 64 that resided on a desk with wheels that was supposed to be rolled into each room as part of every patient interaction.
Leadership would always emphasize that all these things were important to complete so that during handoff the next nurse would be informed about the patient and the outgoing nurse would not look foolish and have nothing to say. There was even public shaming associated with random reports generated by the charge nurse and posted showing who had initiated an MAR request for acetaminophen, but failed to do a pain assessment 20 minutes later.
It has always been this way
The context of this story includes technology that is not adequately mapped to the work at hand. Nurses carry handheld phones that lack caller ID so that when they are interrupted by a call, they struggle to decide whether they should walk away from a patient to take a call or wait for the caller to call back. There still is a mix of paper and electronic charting. Some devices automatically report information to the EMR while some do not.
Since information is collected in an asynchronous manner and by multiple sources—nurse, tech, integrated device, phone, provider, imaging or other department etc…–there is no timely way for anyone to see a holistic view of the patient. Ultimately, this environment ensures that information will not be assimilated into the record, that interventions are tied to outdated results, and that clinicians are unable to communicate effectively.
The challenge I see at every hospital that I visit is that the folks who really care are swamped by those who have just accepted that everything is broken and resign themselves to putting in 8 to 12 hours of misery to get their paycheck.
Call to Action!
No matter your role in healthcare, we owe it to ourselves to cultivate good leaders. If you see someone with ideas, encourage them to speak up. Develop a clear mechanism to bubble these ideas up so that in your workspace they are considered, can be implemented where it makes sense, and their effectiveness evaluated.
Ensure that there is a clear list of priorities for the institution that everyone understands. Since on many occasions, if not consistently, things will be left undone, determine which will have a lesser impact so that they can be skipped.
Have an ongoing evaluation strategy to review these tasks and determine, if they are frequently not being done, if they are truly critical to the mission and should remain priorities.