Health care reform is the hot topic of the moment. But of all the proposals being thrown around, which one will actually address the quality of care? In a July 5 op-ed piece for the New York Times, Paul O’Neill, former U.S. Secretary of the Treasury, asked, “Which of the reform proposals will eliminate the millions of infections acquired at hospitals every year? Which of the proposals will eliminate the annual toll of 300 million medication errors?” These are excellent questions that both lawmakers and clinicians need to consider.
According to O’Neill, over $1 trillion is wasted annually as a result of “process failures” in our hospitals. By increasing our adherence to common, evidence-based best practices at the bedside, we clinicians could have a real impact on health-care quality and cost. But what will it take to get clinicians to wash their hands 100% of the time? What will it take to have every hospital in the country using the IHI’s Central Line Bundle?
How does such adherence relate to health care reform? O’Neill writes, “What policymakers tend to forget is that only the people who do the work can make this happen. Legislation can’t do it, regulation can’t do it, infection-control committees can’t do it, financial incentives and disincentives can’t do it. But excellence is possible, and it has been demonstrated.” Indeed, some hospitals successfully use low-tech, evidence-based best practices to reduce health care–associated infections. Improving the quality of care at the bedside by following evidence-based best practices 100% of the time is one way clinicians can help to reform health care and control costs.
Why is adherence to known best practices so difficult to maintain? In my experience, this question leads to more questions than answers. My team performs quality assessments related to IV therapy in hospitals. We look at what’s going on at the patient’s bedside; we observe and talk with nurses. I was in a bedside role for over 20 years before doing this work, and I believe that lack of adherence is most often caused by a lack of knowledge. During an interview I often ask a nurse why she does something a certain way. I’m sure you’ve heard the most common answer: “Because I’ve always done it that way.” Why is this response still considered OK? What are your thoughts?
—Peggy L. McDaniel, BSN, RN, is an infusion practice manager.