Have the trends in Healthcare Quality and Safety changed over the last 20 years?

As a new graduate nurse, I worked the night shift at a small community hospital. I had completed an associate degree at a local community college and went to work every shift terrified I wouldn’t know everything and worse, something bad would happen.

Nursing school was one of the most difficult accomplishments in my lifetime. I was the first in my family to graduate college and delighted to be in a field where the sole purpose was to help people. I had memorized anatomy, lab values, perfectly demonstrated technical skills and passed the NCLEX exam. I was fortunate to participate in a new nurse graduate program at the hospital and had phenomenal mentors that assisted me in the practical application of the years of education.

Admittedly, Electronic Medical Records were relatively new at the time, and there was still much documentation on paper. Have you ever tried to decode a physician’s handwriting? Speaking up about a concern was often met with condescension.  While quality and patient safety are at the heart of nursing and healthcare, terms like high reliability, human factors engineering, human error prevention tools, and Fair and Just Culture were not a part of the everyday vocabulary of health systems at the time.  When a mistake was made, the consequences for the employee were based on the severity of the patient outcome, more times than not, without a review of the system for improvement opportunities. 

Since the early 2000’s there has been a concerted focus on improving the culture of healthcare to drive quality improvement and patient safety. Government funded training, development of Patient Safety Organizations as a result of the Patient Safety Act (2005), and the addition of safety-related accreditation standards are key initiatives that served as a launch pad for safety for healthcare organizations. 

The research and testimonials of these efforts have been extremely positive for patients, physicians, employees, and organizations.

Twenty years later, do we have any perfect healthcare systems, hospitals, outpatient care or long-term care facilities? No, there will always be opportunities for improvement! My observation is that healthcare organizations who embrace a culture of Quality Improvement and Patient Safety excel in patient experience, quality of care, employee engagement and outcome metrics. Executive leaders, physicians and the board are key in setting the tone for an organization to transition from a punitive culture to one of learning and proactively implementing processes and systems that are designed to integrate with the team’s workflow. 

Each organization is at a different place in their journey to improve Quality and Safety. Healthcare is one of the most complex systems, but the mission is simple, take good care of people. My professional decision to transition towards a corporate role from patient care was a difficult one. That transition led to the ability I have today to advocate for safe patient care, the construction of workflows that support the team in safer processes and the discovery of one of my life’s passions.