By Mary D. Naylor, PhD, FAAN, RN. Dr. Naylor is the Marian S. Ware Professor in Gerontology and director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania School of Nursing. She is also the National Program Director for the Robert Wood Johnson Foundation program, Interdisciplinary Nursing Quality Research Initiative, aimed at generating, disseminating, and translating research to understand how nurses contribute to quality patient care. She was appointed to the Medicare Payment Advisory Commission in 2010.
Building on the Future of Nursing report’s call for nurses to fully engage with fellow health care professionals, a new report from the Institute of Medicine, Best Care at Lower Cost, calls on nurses and others in the health care system to apply emerging tools, technologies, and approaches to yield lower costs and better health outcomes. I had the great fortune to serve as a member of the study committee.
The complexity problem. The report couldn’t be more timely or relevant, particularly for nurses and the patients they serve, given the complexity of the current health care system. Administrative and workflow inefficiencies limit hospital nurses from spending more than about 30% of their time on direct patient care. With increasing specialization, modern medicine now includes nurses in more than 50 specialties. To successfully coordinate a patient’s care, nurses need to communicate and collaborate with patients, family caregivers, physicians, pharmacists, social workers, and many other team members.
The complexity of patient care can blur accountability. Among hospital patients, 75% are unable to identify the clinician in charge of their care. Breakdowns in communication also can contribute to poorly coordinated care. As a result, almost one-fifth of Medicare patients are rehospitalized within 30 days, at a cost to Medicare of $15 billion in 2005 alone.
The ‘care team’ model. The report envisions a health care system with organizational cultures and incentives that prioritize leadership, team care, transparency, safety, and continuous improvement. And at the core of a continuously learning system is the care team, centered on the patient and comprised of family caregivers, clinicians and others involved in the patient’s care, within and between critical transitions in care settings.
What would a continuously learning health system mean for nurses? At every stage of patient care, nurses remain focused on the patient’s goals. They help ease the complexity, stress, and confusion of the health care system. When forming a care plan, they’re connectors who can help bridge clinical knowledge with a patient’s care needs. During a course of care, they’re explainers who can help patients understand and implement their care plan. And during care transitions, they’re facilitators, connecting the hospital, community, home, and other providers and services involved in the patient’s care.
Nurses are the common thread linking all components of a patient’s care, and are therefore also the key to advancing a less complex, less costly health care system. Continuously learning health care cannot wait.