needs of nurses and patients. Also, there is an inertia in hospitals that works against change and a “not invented here” syndrome that keeps promising innovations from other places from being accepted. Until departments come together to redesign care around the needs of patients, hospitals will continue to develop in a haphazard way.

Minnier noted that many leaders in hospitals do not fully understand the issues that face nursing and fail to keep the care of patients front and center, “whether [because of] unaligned incentives, lack of knowledge, or lack of understanding.” National programs such as Transforming Care at the Bedside can elevate issues to a level beyond the institution and lead to meaningful change. Also, one step the IHI has taken is a program to build the skills of physicians, nurses, students, administrators, and others to fix broken processes on the front line.