Measuring Quality & Safety From the Patient's Perspective

                     


We continued this week with Patient Quality & Safety III. I expected to learn more about quality and safety with respect to our patients. When reading the chapter this week it talked quite a bit about measuring patient satisfaction. It is really the only way to determine how we are doing or at least how the population we are affecting perceives how we are doing. Because face it, we can't please everyone, every time.

The text puts the patient's viewpoint in three categories:

1. Measures of preferences - meaning what a patient's expectations are and how well those expectations were met. This could include waiting time, time spent with doctor, etc.
                                   

2. Evaluations - meaning how the patient perceived their care and whether they believe that it was good care or bad care.

                                         


3. Reports of Health Care - meaning a non-biased account of the care received or what actually occurred regardless of what the patient thought.



What surprised me a little was including doctors and nurses in the "patient" category. In other words, when the doctor's or nurses use facilities such as outpatient referrals, labs, or rehabilitation services, they are also in the position of the patient to evaluate their perceived acceptance of care. Interesting idea, isn't it.

                 

I always try to incorporate what I learn in class to my clinical experiences. I recently started working nights and I feel that I have less time to really connect with the patient. Therefore, it is that much more important that the time that I do spend with them is time meeting their needs and helping them to have the best care possible. I am their connection to the doctor, the source of timely pain relief and many other important aspects of their experience that can help them to heal more effectively. What I do, what we all do working as a healthcare team matters to healing. Patient satisfaction means that our patients are on the road to healing and recovery.

Quality Improvement II

This week I expected to learn more about Safety in nursing. Of course, improved safety means improved quality. I learned that Quality and Safety is a numbers game. My favorite quote of the week was, "If you can't measure it, you can't improve it". This is so true! Somewhere in that hospital people are working hard with all the data about patient care, infections, falls, survey results, and other mishaps or improvements. They are filling charts, graphs, and number lines with all this information and filtering back results to departments on areas that need improvement. This is always a good thing. I can see why statistics was a prerequisite for this degree.

I always feel good about learning more to ensure my patients are safe. I don't ever want to be responsible for someone getting hurt or contracting an infection because of something that I did. I will take all that I learned this week and put it in the bigger picture. It is sometimes easy to just pay attention to the task at hand and not look at the big picture. For example, some may find it an annoyance to put on a gown, gloves and mask in a patient's room who is on contact precautions. They may feel that they will only be in there for a minute or they will wash their hands really good when they are done. However, if you see the big picture, you want to keep all your other patients safe. So, it is so very important to put on all that protection, not necessarily for you but for all the other patients you will come in contact with.

I will keep the big picture in mind. It isn't every job that someone has where they have to worry about causing harm to others or even death. What we do is too important. Constantly working to improve quality of care is essential. 

Our topic this week is entitled "The Outcome Model of Quality". I expected to learn more about quality of care in the work force. I feel as though we are learning the same thing over and over but by removing a thin layer at a time. 

The Outcome Model of Quality focuses on the structure, process, and outcomes of quality improvement and quality care. It is the 'how to' behind learning to increase quality of care in the work place. Benchmarks are created and the quality of care is based on those benchmarks. The benchmarks are in line with what the standards are for the industry. They are somewhat averaged out to find a industry 'norm' and then the care for that facility is based off of meeting that benchmark. It is very similar to setting goals and striving to meet those goals but it is an elaborate goal set using the standards of industry.

As a nurse, I want more than anything to help my patient and improve their status. When I start on my shift I am always looking for ways to improve my patient's circumstances. It is tremendously helpful that the hospital in which I work sets their benchmarks high so as I follow the procedures in place, I am doing all I can to help my patient. At the same time, my individual benchmarks are in looking for ways to provide comfort and care, along with the medical side, to improve their stay and help them feel better on a different level. 

I really like anything to do with goal setting or setting a benchmark for improvement. I think if we don't set our heights high enough, we are never moving in the right direction to progress. We can become stagnant and in a constant state of existence, or worse yet, floundering. I think that health care organizations benchmarks should be high. People are going in for help and the industry needs to be ready to provide the best possible care, always looking forward to improvement and continuity. 

                                      

 Our topic this week covered the roles of health care individuals. I had expected to learn about the different roles we play as health care workers. We each play our own "titled" role as well as many sub categories. For example, the nurse is active in the clinical care of the patient but also has the role of patient advocate. Also, each interdisciplinary team actively participates in their assigned role. Together, we form a team responsible for excellency in patient care.

                                           

I learned how important our individual roles are in providing quality patient care. If even one of the team is not fulfilling their assigned role, there is a gap in patient coverage. A gap can mean anything from someone not receiving the care they had expected to the extreme of injury or even death. 

The team test we had this week was a great summary of how quality and safety in healthcare is an ever changing and always expanding field. The models such as Kotter's model or Berwick's model of improvement offer great strategies and maps to follow in order to implement effective change. I always appreciate the time spent reflecting as I feel this is where we have the greatest potential to find areas of weakness that can be turned to strengths.

It is so important to me that there are no gaps in my patient's care. There is an advantage to "following" a nurse during orientation or clinical. This perspective makes it a little easier to see what the patient is experiencing. I have been reflecting on that lately and looking for ways to fill the gaps that the patient's may have in their care. It may be that a nurse is so caught up in a routine that they aren't taking a minute to stop, look at the patient in the eye, and really listen to the answers to our questions.

I like checklists like we reviewed in this week's test. I like to have tangible "to do's" that help me play my day. I am learning how to incorporate those checklists with improved patient care. I think we can take the models for quality improvement in healthcare to a refiner level and apply them to our individual patient care on a daily basis.