1. Hader, Richard RN, CHE, CPHQ, NE-BC, PhD, FAAN

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How can someone new join your organization and bring issues and concerns to your attention that you never knew existed? Is it because you've become so accustomed to the issue being wrong that you never thought to correct it yourself? If that's the case, you're not alone. We get used to visualizing our organization within a routine paradigm, becoming "home blind" and failing to see the imperfections within our own area of responsibility.

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Seasoned leaders are particularly vulnerable to this management trap because they become familiar with compromised practice. Without intent, we tend to ignore disturbing issues because the unacceptable becomes so ingrained in our culture of performance that it insidiously becomes the norm. Although you may have repeatedly attempted to resolve the issue and failed, further attempts may be dismissed because of competing priorities. It's imperative that leaders understand that habitual poor practice or unacceptable staff interpersonal or clinical performance will lead to chronic problems that may result in serious consequences if they aren't swiftly resolved. And you must be aware that failing to implement sustainable interventions to solve problems could destroy the principles and standards of your business unit, which will ultimately deteriorate the care that's delivered to patients.


Procedures and practices that are most commonly performed are those that are highly exposed to poor performance. One of the most frequent tasks that a nurse performs is medication administration. Nurses perform this task repeatedly and it's usually done without incident; however, we're well aware that errors in medication administration may cause severe injury or even death to patients. Yet, we're also aware that our practicing colleagues continue to neglect to consistently follow the rules of medication administration. It isn't until an unintended consequence is experienced that we tend to reexamine practice and make sustainable change.


Seeking guidance and support from colleagues, getting staff involved in monitoring the quality of care delivered, and soliciting input from patients will all help sustain a consistent state of readiness and excellence in practice. You should call on your colleagues in other departments to come to your area, conduct a survey, and inform you and your staff members what they find. Your colleagues will be able to quickly identify issues that you may no longer see because you've developed biases of which you weren't even aware. A trusted colleague may also provide you with helpful tools and strategies to resolve nagging issues.


Staff members need to be engaged in constant performance improvement activities to ensure that they continue to provide quality care. Education in quality improvement strategies and techniques should be provided to staff members, who should share the results with their colleagues. Getting the staff nurses involved will spread the responsibility of governance to all members of the department, which will allow you the opportunity to coordinate and monitor changes in practice.


The "home blind" phenomena can easily be remedied if you take the time to view your operations through the eyes of a patient. Start by asking your patients about the care they believe they're receiving within your department. This strategy will certainly open your eyes and provide a framework on which to build and sustain a culture of excellence.


Richard Hader

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