What is excellence? I believe excellence is an enigma to many healthcare providers. The frustration with achieving excellence seems to lie in the fact that we're trying to obtain it by treating it like a problem that can be solved instead of a condition that needs constant care. This problem-solving approach can be seen in the best-practice checklists and standardizations that have become the rage.
Under this approach, providing care has become a series of steps that must be completed, and success is measured by meeting targets such as low complication rates or lengths of stay. I think this approach is flawed because the focus on the standardization of care is causing practitioners to rely too heavily on the protocols and not enough on their emotional intelligence.
When we use problem-solving or left-brain thinking and things go well, we rationalize that we've mastered the process. This perception of mastery lets us develop a trust that the process will work every time. But confidence in the process causes us to lose our objectivity and atrophies our ability to pick up on the subtle changes in a patient's condition that can mean the difference between life and death. Perhaps our focus on documenting steps in the universal protocol without making sure we're committed to the spirit of the steps is why we're still performing wrong-site surgery today.
Let me be clear: Finding ways to improve quality is important and necessary. What I'm suggesting is that the focus on checklists and protocols, while important, isn't the complete answer to achieving excellence. We're also in the business of caring for human beings whose spiritual and emotional needs must be addressed-even though that care doesn't show up in current turnover time algorithms or best-practice pathways-if we're to achieve our goal of great care.
Consider the industry that many say healthcare should emulate. The airline industry has done great work in improving quality and making air travel the safest method of transportation. Despite that safety record, airlines have some of the lowest customer satisfaction scores.
Why? Because people believe the plane will get them safely to where they're going, but they hope that they have a seat, the plane will be on time, and their luggage will get there with them. The airline's effort to improve safety was important because it saved lives but it didn't earn them their customers' respect or satisfaction.
The airline industry forgot the things their custo mers valued in addition to being safe. They'll leave passengers sitting for hours on tarmacs or strand folks without batting an eye, leaving people frustrated with the experience. Then airlines wonder why they're forced to honor a passenger's bill of rights.
Is this really the group we want to emulate? Do we really believe checklists alone will be enough to get us recognized as excellent? I think the answer lies in each of us embracing a combination of evidence-based best practices and the caring principles we learned in nursing school.
In almost 30 years as a nurse leader, I've received hundreds of letters from patients about their care. Not one ever talked about how well the nurse passed a medication or gave a shot. They all spoke about how the nurse either did or didn't make them feel valued in the most dehumanizing time of their life. Like airline passengers, our patients are clearly saying they value both quality and caring.
Colleagues, we own the profession of nursing. We shape its future. It's up to us to ensure that future reflects a balance between great physical care and comforting spiritual care. We need to stand up and be the change we want to see. If we do, our profession and patients will thank us and we can all proudly claim true excellence in practice.
William Duffy, RN, MJ, CNOR
Vice President, Nursing NorthShore University HealthSystem Evanston, Ill.