Keeping Patients Safe Transforming the Work Environment of Nurses (2004) / Chapter Skim
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8 Implementation Considerations and Needed Research
8 Implementation Considerations and Needed Research
Pages 312-328
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From page 312... ...
Rapid growth in beneficial technological innovations has occurred in all industries and has sometimes brought unanticipated risks to consumer safety, ranging from identity theft to new sources of environmental pollution and occupational or consumer injury. All industries are affected by changes in the workforce, such as its declining size and aging as the baby boomers reach retirement age.
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From page 313... ...
However, while this increase is very high, it represented the first slowing of the growth rate in 5 years, a siowclown that occurred in all four categories of health care spenciing inpatient and outpatient care, prescription drugs, and physician services (Center for Studying Health System Change, 20031. · Although the transition to less-restrictive managed care has eased financial pressures on providers, cleclining Medicare and Meclicaici payments continue to squeeze hospitals and physicians.
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From page 314... ...
· Private health insurance premiums increased an average of 15 percent in 2003 the largest increase in at least a decade (Center for Studying Health System Change, 20031. Consequently, employers are shifting more costs to employees.
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From page 315... ...
MULTIPLE, MUTUALLY REINFORCING SAFEGUARDS ARE NEEDED As the evidence in the preceding chapters attests, there is no silver bullet, or shortcut for achieving patient safety. The work environment of nurses contains the basic organizational production processes and opportunities for human error well described by experts in organizational safety, as captured in the framework presented in Chapter 2.
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From page 316... ...
Some of the recommendations (e.g., establishment of a strong nursing leadership position, education and attention of governing boards with regard to safety, and adoption of management practices that are supportive of patient safety) are not likely to have significant immediate cost implications; other recommendations, such as limiting nurse work hours and ensuring safe staffing levels, may have such .
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From page 317... ...
Yet we repeatedly noted how often patient safety practices identified from the evidence reviewed for this study were the same as those recommended by organizations studying the nursing shortage, worker safety, and patient satisfaction. We note that retention of nurses and other health care workers in short supply, increased patient satisfaction with care, and potentially some return on financial investment may also result from undertaking the recommendations of this report.
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From page 318... ...
Moreover, the research that leci to the creation of the magnet hospital designation denoting hospitals that have higher levels of nurse retention and recruitment in the face of nurse shortages and an environment competing for the available nurse workforce founci the following workplace characteristics to be associated with better nurse recruitment and retention (McClure et al., 20021: · Participatory management that involves nursing staff at all levels in decision making. · Able, qualified and effective nursing leaclership.
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From page 319... ...
, have been linked to patient satisfaction, findings from a study of magnet hospitals and hospital units with similar organizational traits suggest that features of nurses' work environment found in magnet hospitals also influence patient satisfaction (Aiken, 20021. Moreover, increased patient satisfaction is linked to adequate nurse staffing levels (Luther and Walsh, 1999)
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From page 320... ...
, favorable benefits were estimated to accrue to patients and society at large, but effects on the provider of care generally were judged to be financially unfavorable (Leatherman et al., 2003~. However, these case studies did not analyze the costs to HCOs due to errors in health care that might have taken place in the absence of these interventions (i.e., lipid clinic, diabetes management programs, a smoking cessation program, and a workplace wellness program)
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From page 321... ...
An HCO also may incur additional patient care costs created by the error, such as costs associated with transfer to higher level of care, use of additional diagnostic resources, or an extended hospital stay.) If legal claims are made, direct costs incurred include legal fees, settlements and payments, and the time expended by risk management personnel.
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From page 322... ...
Research findings and dissemination of practices that individual HCOs have found successful in improving patient safety will help HCOs as learning organizations add to their repertoire of patient safety practices. The committee calls attention to several areas in which, at present, information is limited about how to design nurses' work and work environment to make them safer for patients.
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From page 323... ...
Research comparing different layouts of nursing units and patient rooms would help identify principles and practices of safer workspace design. A Standardized Approach to Measuring Patient Acuity As discussed in Chapter 5, HCOs use a variety of tools to measure patient acuity as a basis for allocation of nursing staff and other managerial decision making.
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Research is needed to identify strategies that can help nurses combat the effects of such work hours. Research on the Effects of Successive Days of Working Sustained Work Hours Continued research is needed on the effects of sustained work hours.
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From page 325... ...
· Development and testing of a standardized approach to measuring patient acuity. · Determination of safe staffing levels within different types of · ~ nursing units.
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From page 326... ...
. No end to errors: Three years after a landmark report found pervasive medical mistakes in American hospitals, little has been done to reduce death and injury.
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From page 327... ...
1999. Moving out of the red zone: Addressing staff allocation to improve patient satisfaction.
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