“The American health care delivery system is in need of fundamental change. … Trying harder will not work. Changing systems of care will.”
Marilyn Chow, RN, DNSc, FAAN, echoed the concerns of the Institute of Medicine when speaking at the fifth annual Littlefield Leadership Lecture in the Health Sciences Learning Center (HSLC) on September 17, 2004, sponsored by the UW-Madison School of Nursing and named for Vivian Littlefield, dean emerita, whose vision for health professions curricula focused on interdisciplinary education.
Facing an audience of approximately 350, the vice president of patient care services for Kaiser Permanente presented her lecture, “Leading from the Middle: Essential for Quality Work Environment.” Projected on the wall behind her, via videoconferencing, sat lecture attendees from Gundersen Lutheran in La Crosse, designated the UW-Madison Western Campus for Nursing.
With a focus on needed reform in health professions education and health care systems, Chow offered scenarios depicting errors in health care delivery—some fatal—driven by lack of communication between health care professionals. The descriptions segued into examining the relationship between quality patient care and teamwork among health care professionals.
She compared the health professions—medicine, nursing and pharmacy—to tribes, each speaking a different language. Teamwork among the tribes or disciplines, Chow emphasized, is essential for quality patient-centered care. Once communication is well-established between the tribes, “hand-offs between each health discipline become smooth, like a good relay.”
Being better prepared to provide the highest quality and safest care possible, explained Chow, requires establishment of core competencies in health professions education. The HSLC, she noted, is perfectly positioned to carry out the Institute of Medicine’s vision for health care curricula:
All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice, quality improvement approaches, and informatics.
In practice, noted Chow, better preparation to give quality patient care requires a framework for establishing communication between members of the health care team. Chow sited SBAR(situation, background, assessment, recommendation) as a useful model for strengthening communication (see http://www.ihi.org/IHI/Topics/PatientSafety/SafetyGeneral/Tools/SBARTechniqueforCommunicationASituationalBriefingModel.htm).
As Chow explained, it is necessary for nursing to engage its role in the workforce to “lead up”—a term taken from Michael Useems’s Leading Up, meaning “a driving urge to make things happen on high, an unflinching willingness to take charge when not fully in command.”
Nursing roles (RNs, LPNs/LVNs, nurse assistants), as reflected in Chow’s data, constitute 54 percent of all healthcare providers and, therefore, are an integral part of a health care team. Accordingly, nurses must show initiative and assertiveness in communication with medicine and pharmacy in order to keep patients safe.
“The upper echelon must listen to people sounding the alarm,” noted Chow. Nurses are the front lines for patient safety: They coordinate and integrate care, perform surveillance and rescue of patient status, intercept errors, and support and educate the patient. Their leading up is essential for patient safety reform, she explained.
“Be a purple cow!” were Chow’s parting words to her audience. Alluding to a best-selling marketing book by S. Godin, titled Purple Cow, she encouraged her listeners to think big, long, and transformational—initiate change in health care systems by engaging the frontline.