1. Doucette, Jeffrey N. DNP, RN, CEN, NEA-BC, FACHE

Article Content

Q Lately it seems like I'm constantly juggling deadlines and priorities, and barely meeting the needs of my staff and patients. What suggestions do you have for dealing with the ever-increasing pressure?

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

This type of pressure exists at all levels of leadership throughout our industry. The shift from volume to value-based payments, coupled with the need to balance rising costs, creates the perfect storm of high-stakes leadership. The most effective way for you to spend your time and energy is focusing on patient experience-safety, quality, and service-in that order. As a nurse leader, you can't go wrong if this is your primary objective. Let's explore a few ideas for each key element of the patient experience.


Safety must supersede everything we do to create highly reliable processes that reduce or eliminate variation and deliver the best possible outcomes. I recently attended a meeting where the speaker asked anyone in the room who had been harmed as a result of a medical error to stand, then anyone who knew someone who had been harmed by a medical error, then anyone who had a safety event that resulted in harm at their organization in the past 12 months, and last anyone who had been part of a process breakdown that resulted in harm. By the end of this brief exercise, everyone in the room was standing. It was a stark reminder to me that we must do everything we can to keep our patients safe. Place a high priority on safety rounding, eliminating care process variation, and error proofing. This work crosses all of your key constituents and allows you to have a highly visible presence in meaningful work.


Delivering high-quality outcomes is the second area of focus in the patient experience triad. Spend time examining how structure and process affect outcomes. Your role is to create a vision for quality, ensure that your staff members have the tools and equipment they need to do their work, and confirm that an ongoing monitoring program is in place. A recent experience in my own organization reminded me that we're very good about monitoring compliance in healthcare, but we aren't always great at defining and measuring outcomes, especially those that are nurse driven. For example, it's important to monitor hand hygiene compliance, but equally important to focus on how it impacts reduced hospital-acquired infections.


Finally, a significant portion of your time should be spent on ensuring that you're delivering excellent service in a patient-centered manner. One of the most important interventions in this regard is to round on your staff, physicians, and patients. You'll get more information about the level of service on your unit from patient rounds than any other intervention. Purposeful rounds should be "eye to eye and heart to heart," meaning that you sit at the patient's level whenever possible. Prepare meaningful questions and explore important aspects of the patient's care, such as care coordination, medication management, communication, and teamwork. Too often, I see a nurse leader walk into the room, say hello, and ask "how's everything going?" The patient says "fine" and the nurse leader leaves. This type of interaction does nothing to impact the patient's perception of service and provides few tangible items to address. In addition, use your time in the room to observe for issues related to safety and quality. Are items within the patient's reach? Is the communication board up to date? Are medications properly labeled? When you focus your efforts in this way, you maximize your efficiency and are able to address numerous elements of the patient experience in a single encounter.


There's no question that these are challenging times in healthcare, but they're also exciting times. We have the opportunity as nurse leaders to be on the forefront of defining an excellent patient experience in all elements-safety, quality, and service.