The Richard and Hinda Rosenthal Lectures 2003 Keeping Patients Safe -- Transforming the Work Environment of Nurses (2004) / Chapter Skim
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Management Practices, Work Force Capability, Work Processes, and Organizational Culture--Ada Sue Hinshaw, Ph.D., R.N., F.A.A.N.
Management Practices, Work Force Capability, Work Processes, and Organizational Culture--Ada Sue Hinshaw, Ph.D., R.N., F.A.A.N.
Pages 6-13
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From page 6... ...
Essentially, we are looking at threats that can arise to patient safety in four areas and strategies that we have looked at and recommendations that we have made in the same four areas: management practices, work force capability, work processes, and organizational culture. Altogether, there are 18 recommendations, and 10 of them are primarily for the health-care organizations in the country.
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From page 7... ...
We also looked at five different management practices, and we particularly draw your attention to these because they are ones that are very helpful in terms of increasing safety for patients: first of all, balancing efficiency and reliability; secondly, creating and sustaining trust. This is trust in two directions.
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From page 8... ...
The next recommendation deals with professional associations and philanthropic organizations, and looks for collaborations that will help health-care organizations to advance their evidence-based management practices. This involves putting together academicians and managers and nurses and the multi-disciplinary kind of team that was evident in our particular team, in order to think through together what we can do with management practices that will increase safety and make for strong and positive environments.
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From page 9... ...
First of all, we are recommending that the DHHS should update the 1990 regulations that specify minimum nursing home staffing standards. It was over a decade ago that these particular nursing home staffing standards were established, and at this point those standards called for a registered nurse (RN)
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From page 10... ...
We then looked at staffing levels for nurse assistants who provide the majority of care in nursing home facilities. They are currently carrying about an average of 11 patients each, which is a very high number and does have some real consequences in terms of patient safety.
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From page 11... ...
There is some precedent with Centers for Medicare and Medicaid Services current in the Medicare/Medicaid service data. There is nursing staffing data and so there is some beginning here, but we are also recommending that one of the things that needs to be built into the forthcoming hospital report card is staffing data because the relationship between nurse staffing and outcomes and safety is so strong.
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From page 12... ...
The error rates increase rapidly after 12 hours of work, and also as we know fatigue has some very nasty effects on our ability to problem-solve and do critical analysis and to react quickly. So, we have recommended that states should prohibit nursing staff from providing patient care in excess of 12 hours per day or 60 hours during a 7-day period.
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From page 13... ...
The next is the National Council of State Boards of Nursing working with other colleagues to really begin to look at how they can discriminate between latent errors, as Don defined them earlier, and errors that are actually human or errors that involve willful negligence or intentional misconduct. Congress needs to pass legislation so that in fact people can report errors and near misses in errors and feel confident that they will not be either sued or maligned for providing information that will improve patient care.
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