Nurse Executives Upbeat at Annual Meeting

I spent the last few days at the American Organization of Nurse Executive's annual meeting in Indianapolis. I had wondered how the difficult past few years and the recent dramatic healthcare reforms would affect the nurse executives' mood. I was pleasantly surprised to discover an upbeat group who are optimistic about the future and eager to embrace the challenges and opportunities presented by the reform law.

Patient advocacy is at the heart of nursing, and discussion of healthcare reform focused on increased patient access to care and removing the most egregious health insurer practices.

With its largest attendances in years, the conference focused on healthcare transformation within four areas: patient safety and quality, healthcare delivery, technology, and workforce development.

The first two topics dominated most of the discussion, particularly after the fascinating plenary session from Harvard Adjunct Prof. Lucian Leape, MD, entitled "Making Patient Safety and Quality of Care a National Priority."

Leape, the father of the modern patient safety movement says: "Healthcare has become a production line. We think more about nursing staff ratios than we do about nurses."

He believes healthcare is undergoing a paradigm shift where we move from one-on-one care to collaborative team-based care where nurses are leaders and coordinators. He wants one-size-fits-all hospitals to be replaced by accountable care organizations, where the norm includes:

1. Standardization of care that benefits all patients
2. Patients engaged in their care
3. Care provided by inter-professionals teams, often led by nurses—characterized by collaboration and respect
4. Accountability:
   • Individually—we have to hold ourselves and our colleagues accountable
   • Internally—organizations must be honest, open, and transparent
   • Externally—outcomes should be made public

To get to this vision, Leape works with the National Patient Safety Foundation, within the aptly named Lucian Leape Institute, on several transforming concepts:

1. Integrating healthcare within and across organizations
2. Expectations of full transparency in patient care
3. Encouraging consumer and patient engagement and involvement in care
4. Helping people find joy, meaning, and pride in their work
5. Improving the safety of healthcare workers
6. Reforming medical education

Leape says the goals will not be accomplished unless relationships in healthcare improve. "Safety is all about relationships," he says. "Teamwork is the secret of every industry that has succeeded in becoming safe."

Leape quoted Paul O'Neil, former treasury secretary and member of the institute, who says that every worker wants to be respected, properly trained, and appreciated.

The institute is focusing first on reforming medical education. Teaching interdisciplinary collaboration, communication, and respect will be key. "Humiliating and disrespectful behavior by physicians has a corrosive effect," he says, and medical leaders need to teach and demonstrate respectful behavior.

He says that the time has come for relationships in healthcare to be based on respect and only then can patient safety be achieved.