It's the analogy of a process that hinders more than it helps.

Each one of us has had the experience of standing in a grocery line behind a person that questioned the price on every item scanned. The order of this size would normally take 5 minutes, but now that the bag girl had to run back twice for price checks, the checkout time took 10 minutes.  For the sake of illustration, let’s say the local grocery store creates a policy to run for a price check on every 3 items scanned to ensure accuracy.  The result is that it now it takes twice as long, or longer, to scan grocery orders. The store has to double the number of cashiers it needs thus increasing operation costs. The goal was to decrease scanning errors but at what price? They now had 99.9 % accuracy on scanned items but costs of running the store skyrocketed.

The better thing to do would be to deal with problems that are presented on an individualized basis and keeping the standard of efficiency intact.  The unseen reality here is that the number of errors that occur in a hospital are still the minority. Don’t make a policy to deal with the exception. The standard of efficiency has been replaced by bureaucratic systems while the costs of running a hospital continue to rise.

Recently, a nurse told me about a hospital that had a sentinel event (bad event e.g. dying or seriously injured) as a result of restraints. A root cause analysis was done.  The end result was a change in policy.  Now, every floor nurse must sit down at the computer and document a patient assessment and a form every two hours on any patient that has restraints.  Sitting down at a computer, will help outcomes?  Documenting something and actually implementing the action does not always co-exist. The difference in the second scenario is that the nurse now needs a checklist (price check) on everything she does, but in the case of nursing, no one has given us additional help to accomplish the same job.  If you add something to an already full plate then something needs to fall off. What has fallen off this plate is basic care and anything that is not emergent.

A common argument presented is that lives are at stake, so the institution had to deal with the error on an institutional level. Dan Gunter is a blogger for Tom Peters’ health care site and was once part of a committee that dealt with the analysis of such errors. He boldly stated in this blog Dispatches from the New World of Work: Comment on 100 Ways to Succeed: “And I can tell you unequivocally, without flinching or batting an eye, that it was very, very, rarely a problem with someone not knowing what they were doing. Almost every time it was due to someone not really CARING about what was being done (or how)”.

So instead of addressing the real problem (caring), institutions create policies that punish those nurses who have been caring all along by making it clear they won’t trust you. The policy did not change behaviors; it actually created quite the adverse reaction. Institutions serve the system at the expense of actual care.

Nurses, have you experienced a similar scenario throughout your careers?  How have you managed to address these issues at your level?  What advice do you have for others?

About the Author: Kellyann Curnayn RN, BSN, has been in the nursing profession for 18 years. Her experience began in the field of oncology and has broadened to all adult areas within the inpatient setting; all ICU’s and med surg floors.  After floating to many different floors and facilities, she began noting the similarities of problems spanned across institutions and floors.  Her latest endeavor is the publication of A Good Day in Hell: The Flatlining of Nurses Across America and consulting in the area of changing behaviors through development of moral memory (doing the next right thing.)

Click here to read more about Kellyann Curnayn.

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