“What would quality in hospitals look like if health care institutions were as single-minded about serving clients as the Disney organization?”
Last week I attended the 2015 American Nurses Association Quality Conference in Orlando. The conference, which had its origins in the annual National Database of Nursing Quality Indicators (NDNQI) conference, drew close to 1,000 attendees. Here’s a quick overview of hot topics and the keynote speech by the new Secretary of the Department of Veterans Affairs, plus a note on an issue crucial to health care quality that I wish I’d heard more about during the conference.
Most sessions presented quality improvement (QI) projects and many were well done. There were some topics I hadn’t seen covered all that much, such as reducing the discomfort of needlesticks, enhancing postop bowel recovery, and promoting sleep. But projects aimed at preventing central line infections, catheter-associated urinary tract infections (CAUTIs), and pressure ulcers ruled the sessions. These of course are among the hospital-associated conditions that might cause a hospital to be financially penalized by the Centers for Medicare and Medicaid Services (CMS). The ANA also had a couple of sessions on preventing CAUTIs by means of a tool it developed in the Partnership for Patients initiative of the CMS to reduce health care–associated infections.
The keynote by Robert McDonald, the fairly new Secretary of the Department of Veterans Affairs, touted the services and resources available for the 9 million veterans who access care through the VA system. He surprised me and—if the murmuring I heard around me was any indication—a lot of others when he reported that patients in the VA system rated their care higher than did patients at general hospitals. The comment from an attendee: “Well, I guess it’s good once you get an appointment.”
He said the VA was “using the crisis of last year to move forward” and acknowledged that improving access was a priority, noting that the VA has hired 1,578 nurses since last year.
What if? It seemed appropriate that a meeting focused on quality took place at a venue known for its high quality customer focus. What would quality in hospitals look like if health care institutions were as single-minded about serving clients as the Disney organization? I’m not talking about the superficial attempts some hospitals implement, like valet parking or blazer-wearing patient service representatives. What would happen if hospitals embraced and acted upon the evidence showing that poor nurse staffing is related to worse outcomes and increased adverse events and errors, burnout, and higher turnover?
Although staffing is closely connected to quality and safety, there were few sessions addressing this issue. Better nurse staffing would allow time for patient teaching to promote self-care (and perhaps reduce readmissions) and for more frequent positioning to prevent pressure ulcers. The quality measures that hospitals are chasing will happen only when they invest in enough staff to truly meet their clients’ needs.