"When nurses communicate better at the bedside, medication errors are reduced, falls are reduced, pressure ulcers are reduced," he says. "Those are safety issues. When physicians communicate better with patients and nurses, compliance with treatment goes up and coordination of care improves. That's quality."
Intuitively, hospital leaders know that better communication will lead to better results, but Merlino says staff, including leadership, is tasked so heavily that it is easy to lose perspective, especially in a hospital with a lot of patients. He's not endorsing smaller hospitals, but rather a different approach to who is working in healthcare.
"I think that 90% of people who work in healthcare are there for the right reasons," he says. "I think there's probably a percentage who want to do the right thing, but don't know how to do it, and there's a small percentage of people who don't belong here."
Cutting out the small group of healthcare workers who hinder healthcare efforts is no small task, but identifying deficiencies through training and development around service excellence can help he says.