The declaration of a safe and effective care environment in a health care delivery setting is critical to enhancing the welfare of nurses and the safety of patients. The maintenance of a safe and effective care environment in a health care setting entails identifying the sources of errors and then applying the knowledge learned to limit the occurrence of errors as well as the detrimental effects connected with errors (Mitchell, 2008). In the United States, the health industry is the second fastest expanding economic sector, with nursing taking the lead in the health care sector. A study conducted by Institute of Medicine and International Council of Nursing in U.S. reported that the ongoing and projected shortage of nurses is attributed to unsafe and ineffective care environment (Stone, Hughes & Dailey, 2008). Furthermore the report showed that low levels of safe and effective environment negatively affected the safety and quality of patient care. This paper seeks to advocate for declaration of secure and effective care environment in health care sector. In addition, the paper describes existence of unsafe and ineffective care environment as a clinical issue and tries to provide possible solution to address the issue.
Importance of the clinical issue
Assurance of safe and effective care setting has potential of motivating more students to join nursing occupation while at the same time retaining professionals who are already in the health care system. Similarly, declaration of secure and quality care environment ultimately improves the safety and quality of patient care (Carayon & Gurses, 2008). In United States high nurse turnover rates have been linked to poor work environment. According to Stones, Hughes & Dailey, the turnover rates range from fifteen percent (15%) to thirty six percent (36) yearly, a rate which is significantly higher compared to other occupation in health care sector. The costs of replacing nurse professionals is relatively high, for instance it is estimated that in United States the cost of replacing one medical-surgical registered nurse is between 30,000 to 50,000 U.S. dollars (Stone, Hughes & Dailey, 2008). Likewise the cost of replacing one critical care nurse is estimated to be sixty five thousand U.S dollars.
Lack of safe and effective care does not only harm the patients but also presents adverse financial impacts for the insurer, patient, provider and caregivers. According to research conducted by AHRQ (Agency for Healthcare Research and Quality), postoperative sepsis has a prolonged duration of eleven days which costs approximately $ 60,000 per patient (Stone, Hughes & Dailey, 2008). Consequently, this presents heavy financial burden to relevant stakeholders. In addition the research revealed that there are also extra costs incurred by insurance companies due to adverse health conditions such as postoperative sepsis.
Knowledge on organizational elements that advocate for patient and occupational health safety is imperative. Organizational aspects such as safety climate and organizational climate influence existence of safe and effective care environment in health care system. Organizational climate features such as leadership, work norms and decision making directly or indirectly influence patient and occupational health safety (Stone, Hughes & Dailey, 2008). Organizational leaders and managers have authority to directly influence organizational climate thought especially those connected to practice and working circumstances. On the other hand safety climate includes aspects such as accessibility of personal protective equipment, lack of barriers to safe work practices, general working environment cleanliness, good communication, supportive managers and few incidences of conflict. These safety climate features also affect existence of safe and effective care environment in health care sector. In fact, safety climate influences actions of health care employees, caregivers and patients (Carayon & Gurses, 2008). Positive organizational climate positively influences job satisfaction, health workers outcome, patient outcomes and nurse turnover rates.
Safety and leadership curriculum need to be developed and evaluated to address the challenge of poor work environment in health care system. Nursing should be fully informed of job satisfaction among all health care employees. Low job satisfaction has adverse effects on entry of new staff in nursing profession and retention of existing staff. Indeed, low job satisfaction is associated with high rates of job turnovers and increased intention of employees to leave their occupation. Significantly, infrastructure in health care should be improved as it promotes high efficiency, patient safety and increased nursing knowledge.
Patient population
Generally large numbers of patients visit health care facilities in search of health services such as medical treatment, health check-up, consultation and many others. Patient population in any health care setting consists of diverse cultures including but not limited to males and females, young and old, patients belonging to different races and tribes and patients with varying norms, traditions and beliefs. Patients’ culture diversity play very crucial role in provision of safe and quality health care delivery (Carayon & Gurses, 2008). For example, failure of a nurse or physician to understand patient’s culture can result in wrong symptoms and needs diagnosis. Wrong symptoms and signs identification leads to administration of wrong intervention which in turn harms the patient. Therefore, proper understanding of patient’s values, behavior patterns, competencies, perceptions and attitude is paramount in delivery of safe and quality health care.
Moreover, patient population consists of patients with varying clinical conditions (Carayon & Gurses, 2008). Patients’ clinical conditions can be categorized as severe or mild. High patient population in health care setting affects patient safety and quality delivery care. In United States workload burden has been identified as a major challenge affecting health care sector (Carayon & Gurses, 2008). The increasing population in United States has raised demand for nurses. In fact by year 2020 the U.S. population is projected to grow by 18%, this implies increase in health care services (Carayon & Gurses, 2008). Currently in U.S. the number of nurses providing health care does not match patient demand and the shortage has been projected to become severe in future if right strategies are not employed to address the issue. According to Carayon and Gurses, high nurse workloads have adverse consequences on patient safety and effective health care delivery. For example high workloads lead to job dissatisfaction, increased execution and knowledge errors, reduced collaboration and communication time and high nurse turnover.
Solution
In order to enhance safe and quality health care delivery, assurance of safe and effective care environment is crucial. Declaration of safe and effective care environment has the potential to overhaul health care delivery in health care sector. A number of strategies can be employed to achieve this great objective. These strategies involve reducing nurse workloads, motivating health care staff, minimizing errors, promoting multidisciplinary communication, availability of necessary health equipment, good managerial and leadership skills, general health facility cleanliness and hygiene among many others (Carayon & Gurses, 2008).
Patient safety and quality health care is influenced by working environment in which nurses practice (Hughes, 2008). According to Hughes, nurses while in their profession use their skills, experience and knowledge to provide care for different and ever changing needs of patients. Knowledge about the complex nature of health care environment and adoption of appropriate strategies to alleviate its adverse effects is crucial in achieving high quality and safe health care delivery (Hughes, 2008). Human error can be overcome by redesigning systems that display features such as equipment standardization, simplification and automation. Furthermore, these systems should be subjected to continuous improvement to correct any defects that may arise with time. In addition, Hughes asserts that organizational factors within health care setting also affect delivery of quality and safe care.
Research conducted by Institute of Medicine in United States reported that nurses were not satisfied with their jobs and they required better working environment and freedom to effectively address the needs of patients (Hughes, 2008). Changes in nurse working environment should seek to empower and support nurses to deliver safe and quality health care. According to Hughes, strategies that seek to enhance good nurse work environment, acknowledge nurse profession and offer monetary incentives have greater impact in fulfilling nurse professionalism. According to research patient centered strategy has been found to promote patient safety and quality care delivery. Patient centered care requires medical staff to establish good partnership with patient and their caregivers in order to attain collaborative decision making, improve patient know how and impart preventive and self-management skills to patients.
Hughes in his studies advocates for use of evidence based procedures by medical practitioners as a way to realize better patient outcomes and enhance patient’s safety. Evidence based practice requires nurses and physicians to use information and data from credible sources to guide them in their tasks. Finally Hughes emphasizes on inclusion of teamwork and collaboration in health care organization to realize quality and patient safety care. Communication barriers have been found to cause information distortions and misunderstandings among clinical practitioners (Hughes, 2008).
Study conducted by Mitchell identified quality health care as a paramount factor which positively influences patient safety. In fact, quality health care delivery improves patient’s health care outcomes. Patient safety can be realized if health care setting designs care delivery system that minimizes errors, gains insights from error occurrence and embraces safety culture that encompasses patients, medical professionals and health care organizations (Mitchell, 2008). According to Mitchell, patient safety procedures including but not limited to bar coding, complementary resource management, computerized medical order entry and simulators reduce errors and enhance quality health care delivery. Nurse play critical role in enhancing patient safety through integration and coordination of numerous aspects within health care setting Mitchell, P. H. (2008).
A study conducted by Stone, Hughes & Dailey in 2008 revealed that maintenance of safe and effective care environment in health care setting involves identification of sources of errors and then utilizing the insights gained to reduce occurrence of errors and also to reduce harmful effects associated with errors. Restructuring of health care organizational conditions, processes and aspects has direct relationship with patient safety.
According to the researchers Assurance of safe and effective care setting has potential of motivating more students to join nursing occupation while at the same time retaining professionals who are already in the health care system. Stone, Hughes & Dailey argue that thorough understanding of organizational elements improves patient safety and therefore it is equally essential. Provision of right safety culture has direct influence in reducing harmful exposure and harms associated with health care work environment. Safety and leadership curriculum need to be developed and evaluated to address the challenge of poor work environment in health care system (Stone, Hughes & Dailey, 2008). Several studies carried out in United States, Hong Kong, Belgium and Australia have indicated that provision of positive organizational culture promotes increased staff job satisfaction and consequently improved patient safety and quality health care delivery system (Stone, Hughes & Dailey, 2008). Research has found that work environment is related to motivation, behavior and attitude of nurses and physicians. Nevertheless, more studies have revealed that clinicians derive job satisfaction when they practice in work environments which are supportive and cognizant of their profession
Goals
The overall goal is to improve delivery of health care and enhance safety among patients. However, to achieve this main goal a lot of time is required since it involves restructuring the entire health care setting. Short term goals such as recruiting more nurses and physicians to reduce heavy workload among health care staff should be implemented. In addition, better and advanced medical equipment should be acquired to reduce errors and enhance patient safety.
Barriers
Overhauling entire health care setting is costly and time consuming exercise. Various factors can deter realization of safe and effective care environment in long run. Main barrier to achievement of quality and safe patient care is lack of adequate resources such as financial and human resources. Another detrimental factor towards achievement of quality health care delivery is poor leadership.
Relevant stake holders should ensure adequate allocation of funds to health care system. This can be done by formulating policies which allow the federal budget planners to increase fund allocation for health sector. The challenge of staffing can be overcome through changing organizational climate, for instance, through motivating and providing financial incentives to health workers. Leadership training and development of leadership curriculum is paramount in addressing challenge of poor leadership.
Benefits
Assurance of safe and effective care environment acts as a motivation to health care staff. This in turn improves the way medical practitioners deliver health care to patients and consequently increased patient output. According to Stone, Hughes & Dailey (2008), provision of positive organizational culture promotes increased staff job satisfaction and consequently improved patient safety and quality health care delivery system. In addition, the researchers argue that positive work environment reduces high rates of turnover and enhances job retention.
On the other hand assurance of safe and effective care environment helps to reduce knowledge and execution errors thus protecting the patients from adverse events. In addition, quality and effective care delivery reduces lengthy medical operations and consequently patients are relieved the burden of incurring more cost.
Participants and interdisciplinary approach
Realization of safe and effective care environment is not responsibility of an individual it entails inclusion of all members who in one way or another influence health care system delivery. Policy makers, clinicians (nurses, physicians and other Medicare providers), managers and patients have a crucial role in realization of safe and effective care. Policy makers have power to influence financial allocation in health sector, nurses are the ones responsible for delivery of nursing care to patients and managers directly influence delivery of quality care through their decisions. Patients have diverse cultures and therefore their perceptions, attitudes and skills affect delivery of quality care positively or negatively.
According to Carayon & Gurses, teamwork and collaboration is paramount in achieving safe and quality health care. The researchers further argue that poor communication which is a consequence of ineffective collaboration and teamwork results in misunderstanding and loss of information. This in turn adversely affects delivery of quality and patient safety care. Teamwork skills such as flexibility, adaptability, performance evaluation and leadership greatly contribute to achievement of quality and safe health care.
Conclusion
Assurance of safe and effective care environment has the potential of improving health care delivery in health care sector (Stone, Hughes & Dailey, 2008). Nursing are at the heart of attaining quality and safe health care delivery and thus improving working conditions in which they practice is equally important. Research has shown that positive organizational and safety climate improves working environment and consequently increasing the motivation of clinicians to deliver quality and safe health care.
Strategies such as reduction of errors, reduced workloads, patient-centered care, effective communication, financial incentives and many others can be adopted to improve safe and effective care environment (Carayon & Gurses, 2008). Patients’ diverse cultures also need to be considered if quality health care is to be achieved. Significantly, realization of safe and effective care environment requires combined efforts of all stakeholders involved. Teamwork and collaboration skills are paramount in attaining quality and patient safety care.
References
Carayon, P., & Gurses, A. P. (2008). Nursing workload and patient safety—a human factors engineering perspective.
Hughes, R. G. (2008). Nurses at the “sharp end” of patient care.
Mitchell, P. H. (2008). Defining patient safety and quality care.
Stone, P. W., Hughes, R., & Dailey, M. (2008). Creating a safe and high-quality health care environment.
