We've spent more than 2 years leading through crisis and can most likely agree that by no measure have we recovered. This year, we're rebuilding, and it's both energizing and, yes, at times exhausting. Glaring workforce and social disruptions have placed our priorities on well-being, work environment, equity, staffing, and care models, and our editorial pages have been focused on these priorities. Now we're seeing paper after paper about the deterioration of quality outcomes over the past 2 years of the COVID-19 pandemic. For the sake of our patients, and for our team spirit and pride, it's time to get back to the basics of quality.
Regaining the improvements in clinical outcomes we previously saw year over year isn't easy work. But it's grounding, bringing us back to our why and purpose-keeping patients safe and reducing both harm and risk of harm. From the patient and family perspective, their experiences with team communication, teaching-learning, and preparation for discharge are part of their "quality" assessment of our care. I've always considered patient experience a component of quality and safety, and if you've had your own patient experience, it becomes apparent how important it is and why it's a big part of the value equation in healthcare.
The history of quality improvement and patient safety is full of challenges, with national policy changes to incorporate value into payment systems making a positive impact. It's messy though and involves culture work. It's literally never "over"; there's always more to do, and never-ending vigilance can be draining. Pace yourself with patient and organizational goals first. Our conversation last month about ownership of practice as we rebuild our teams also fits here, underscoring the need for engagement.
What actually works? There's a litany of strategies! Partnerships; teamwork; ownership; using structured performance improvement practices; leadership; digging into "why" on patient, local, and system levels; staff engagement; process measures; daily management; standards of work; and more-they all belong in our toolboxes for positive change. A favorite method of one of my directors is "obsession," meaning daily focus until every single caregiver and support staff member are totally on board without nudging or follow-up. Unit champions and peer-to-peer feedback have a role, and when everyone is a champion, you'll have success. There's more, of course, the subject of a multitude of books and articles. The fundamental of staffing is part, but not all, of the journey.
Using an equity lens is a perspective we haven't focused on much in the past. It's expected now. A relatively easy way to start is to look at language barriers as a factor in harm events. Depending on your electronic medical record system and data, you may be able to delve into social determinants of health such as housing, education, socioeconomics, access, health insurance status, neighborhoods, and more. We can make huge contributions to equitable healthcare if we understand how these factors impact quality of care and outcomes.
Laying the groundwork for a culture of safety is related to the work of creating heathy work environments, connecting these two important models for leaders. Effective communication, having a voice, and true teamwork underlie both. The emphasis on shared accountability, transparency, and systems in the wake of the RaDonda Vaught conviction is needed and critical to move forward with the basics of quality and safety.
Yes, it's time to get back to quality, and some of you are probably there already and celebrating victory. Influence others to get there, too.
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