Why Enlightened Self-Interest Improves Patient Care
August 26, 2015 | Dianne Foster
Which would you rather take part in: an opportunity to enhance your skill set, or, a mandated quality improvement program? A recent study illustrates that investing in the professional growth of hospital staff improves outcomes.
What a person does to enhance their own circumstances also enhances the well-being of those they serve. Consider the words of nurse’s daughter and civil rights activist Dr. Dorothy Height:“(Enlightened self-interest) is based on a recognition that I am not diminished but I am gradually accelerated when I work with you. Here’s the important distinction: It is not ‘I am doing this for you.’ Instead, ‘Whatever I am doing, I am doing it with you.’”
In this study, the hospital invested in frontline staff growth opportunities. Many of these had milestones at which to recognize achievement. 47% of frontline nurses became Patient Care Champions on core measures like safety, skin care, and diabetes. Participation in the Clinical Ladder program quadrupled in two years. 100% of Nurse Educators achieved the Nursing Professional Development Certification. And, academic progression for BSN completion and attaining nursing certification exceeded the national Magnet hospital mean.
The hospital fostered engagement by inspiring staff to lend their voices to decision-making efforts. Staff shaped change rather than passively receiving mandates from above. Grassroots participation became the vehicle for quality improvements. Staff took part in the Interdisciplinary Patient Care Services Council and Nursing Quality Council. Nurses joined the IHI Advanced Illness Initiative, the AONE “Care Innovation and Transformation” initiative and the American Association of Critical-Care Nurses Clinical Scene Investigator (CSI) Academy. From the latter, staff developed a Be-CAUTIous initiative to prevent Catheter-Associated Urinary Tract Infections. The hospital also employed a “Dedicated Education Unit” to develop RN preceptors and clinical instructors in an academic practice partnership.
Chief executives acknowledged and honored the frontline in newly established Nursing Center of Excellence Awards. Employees nominated peers for recognition through the D.A.I.S.Y. Award for RNs and a homegrown recognition program called “Caring Heart Award” for non-RN staff.
What they achieved
These shifts in the quality paradigm created focus and support on improvements in patient care and job satisfaction. The results are impressive.
The hospital saved $5,094,432 through the following improvements:
- Patient Falls improved 30% from 2013 to 2014
- HAPU Stage II and greater (Hospital-Acquired Pressure Ulcer) improved 67%
- Central Line Associated Bloodstream Infection (CLABSI) rate was improved 7% (although it was already very low, the goal is to sustain at zero infections)
- Catheter-Associated Urinary Tract Infection (CAUTI) rate improved 42%
Not only did the quality of work improve, but nurses reported greater job satisfaction. The NDNQI RN Survey for Job Satisfaction outperformed 9 of the 11 subscales scored on the Magnet mean. The overall score moved from 55.74 to 59.44 (greater than 60 is highly satisfied). Employee Engagement rose from 3.98 to 4.12. This increase represents a rise from 19th to 47th percentile on the National Healthcare Average ranking.
What it takes
The innovative models of care listed above are not new. But kudos to this hospital for embracing them with a collective mindfulness that connects organizational dots. Too often initiatives are scattered throughout an organization or isolated in silos of thinking and tactics. It all starts with assessing the current state, identifying meaningful dots, making a plan and working the plan.
Most nurses connect with what they do – care for patients and families. When asked why they do what they do, nurses often answer “to make a difference.” Improvement is a measurable difference. How we approach improvement work requires a strategy of engagement that transforms a culture.
It is hard work to change an organization to one of collective mindfulness and accountability. Creating a structure that connects people to their work instead of focusing on the job establishes a culture of self-accountability. True engagement is connecting to why we do what we do. As Simon Sinek says, when we start everything we do with why we do it, we can and will change the world.
Dianne has three-plus decades of clinical and leadership experience in 90-600+bed hospitals. Her expertise in complex hospital operations, patient care environments, and cultivating relationships helps hospitals surpass the status quo.
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