Relations between physicians and nurses are sometimes strained. Physician-nurse conflict, tension, and stress have been thought to be contributing factors in job dissatisfaction and burnout for nurses.
Controversy arises about the reasons for physician-nurse conflict, possible solutions to this problem, and the proper relationship between physicians and nurses.
Conflict and tension do not characterize all physician-nurse relations. In many healthcare contexts physicians and nurses communicate and work together to serve their patients. Conflict can occur between workers in business and professional contexts outside of healthcare, of course. Workers may not get along because of personality differences of various sorts. Workers may perceive they are being treated unfairly relative to coworkers. The organization may create a situation of competition among workers. Sexual harassment can occur. Situations such as these may conflict and tension between coworkers or between supervisor and coworker.I believe that in this instance,management should be made aware of such problems and take steps to address and resolve them.
Some other physician- nurse relationships are causesd by interpersonal conflict. This occurs in many areas of business and personal relationships and sometimes it is due to the particular personalities of the parties involved. Some people are simply less friendly, more impatient, have greater expectations, etc. than others. This can occur in relations among physicians, among nurses, and between physicians and nurses.
Another issue is the power imbalance between physicians and nurses in modern healthcare in the United States is well known. This power imbalance occurs both outside and inside healthcare.
As an adminstrator,vone common recommendation is to improve communication between physicians and nurses. Poor communication can result in unmet expectations and resulting frustration and poor working relationships.
Another suggestion is that there be available an optimal method of conflict resolution. Nurses sometimes avoid conflict or are resigned to it, whereas some form of conflict resolution fostering collaboration and cooperation might help alleviate physician-nurse tensions and achieve better overall outcomes.
An important point to note is that conflict between physicians and nurses is likely to hurt the optimal functioning of the team and result in poorer patient care and lower quality healthcare, so as the administrator i would take whatever steps are necessary to ensure the organizational culture and management support create an environment in which such destructive conflict is minimized and nurses feel more empowered.
As the administrator, I believe in a hospital setting, the head physician executive (such as the medical director) and head nursing executive (such as the director of nursing) should build a relationship of collaboration and mutual respect that can act as a model for others. They should learn each other’s disciplines and contributions. They should also develop an organizational vision of how physicians and nurses should interact. This vision should include expectations of their own and other’s behavior – physicians stating their expectations for nurses and nurses stating their expectations for physicians. The vision and expectations should then be translated into standards of behavior and concrete policies to correct misbehavior (violations of the standards). Inappropriate behavior will not change unless it results in consequences for the perpetrator.
Furthermore, they should examine hospital systems and policies to ensure they are not interfering with the development of better relations; for example, if nurses have to police the physicians’ compliance with medical record policies, collaboration will be difficult. Also, opportunities for collaboration should be pursued – physicians providing continuing education to nurses, nurse serving on credentialing committees, etc. -- where they can develop respect and good working relations.
In conclusion, the problem of physician-nurse conflict needs to be addressed not just by individual clinicians but by a healthcare organization’s executive leaders. Hospital administrators and managers may prefer to avoid dealing with the problem. Rather than trying to sweep the problem under the rug, senior management should work to develop an organizational culture in which inappropriate attitudes and behavior of physicians toward nurses and vice versa are not tolerated.
Sunday, March 18, 2012
PLN 6: How to size up your Hospital?
After reading the article " how to size up your hospital," it gives you an insight on how to determine if a hospital is giving good quality based on certain criterias. For instance how consistently your local hospital gives heart-attack patients a kind of medication called beta-blockers, or what proportion of surgery patients get antibiotics an hour before surgery. These type of criterias gives off certain strengths and weaknesses within a hospital and shows us as consumers if we would like to indulge in becoming apart of that particular health care system or choose one that is better suited based on better quality.
After getting on the leap frog website, I compared two hospitals based on that specific criteria to see which each strength and weakness was of each, of course accoring with the information provided. The two hospitals were CJW Medical Center- Johnston - Willis Campus in rich mond VA, and Anne arundel Medical Center.
Now, after just looking over the different criterias from first glance, it shows that Anne arundel Medical Center fully meets the standards for all of the categories mentioned except for the heart bypass surgery, becasue it does not apply. It shows that this hospial has a lot of strengths to it.
Reviewing the information about CJW Medical Center Johnston- Willis Campus it seems that the ratings are a bit less. For instance in the prevent medication errors, it shows one bar which indicates that the have a willingness to report the errors, but most likely they do not report which shows a weakness in the companys category for preventing medication errors. Also another weakness that this hospital shows is that it does not takes the necessary steps to prevent harm in the hospital, which is represented by one single bar as well.
After changing into different categories,it shows that the stronger hospital still remains to be Anne arundel Medical Center. Another criteria was based off of patient outcomes. The outcomes I chose was Heart bypass surgery, and abdominal aortic aneurism repair. Based on these choices it shows the strengths of Anne Arundel was still high in quality care. In the avoid harm category, it showsit had great progress. In the hospital of CJW Medical center, it still shows this hospital has a lot of weakness in the areas of preventing medication errors, steps to avoid haarm. But the strength based off the categories provides did show that the bypass surgery itself quality and cost were very good.
1.http://www.leapfroggroup.org/cp?frmbmd=cp_listings&find_by=zip&zip=20020&radius=100&cols=oa
After getting on the leap frog website, I compared two hospitals based on that specific criteria to see which each strength and weakness was of each, of course accoring with the information provided. The two hospitals were CJW Medical Center- Johnston - Willis Campus in rich mond VA, and Anne arundel Medical Center.
Now, after just looking over the different criterias from first glance, it shows that Anne arundel Medical Center fully meets the standards for all of the categories mentioned except for the heart bypass surgery, becasue it does not apply. It shows that this hospial has a lot of strengths to it.
Reviewing the information about CJW Medical Center Johnston- Willis Campus it seems that the ratings are a bit less. For instance in the prevent medication errors, it shows one bar which indicates that the have a willingness to report the errors, but most likely they do not report which shows a weakness in the companys category for preventing medication errors. Also another weakness that this hospital shows is that it does not takes the necessary steps to prevent harm in the hospital, which is represented by one single bar as well.
After changing into different categories,it shows that the stronger hospital still remains to be Anne arundel Medical Center. Another criteria was based off of patient outcomes. The outcomes I chose was Heart bypass surgery, and abdominal aortic aneurism repair. Based on these choices it shows the strengths of Anne Arundel was still high in quality care. In the avoid harm category, it showsit had great progress. In the hospital of CJW Medical center, it still shows this hospital has a lot of weakness in the areas of preventing medication errors, steps to avoid haarm. But the strength based off the categories provides did show that the bypass surgery itself quality and cost were very good.
1.http://www.leapfroggroup.org/cp?frmbmd=cp_listings&find_by=zip&zip=20020&radius=100&cols=oa
PLN 5 : HOW CAN WE IMPROVE HEALTHCARE QUALITY?
I recently read an article which talked about the causes of quality problems. It stated how patients suffer harm because of three different types of quality problems. The first occurs when patients do not get beneficial health services. The second happens when patients undergo treatments or procedures from which they will not benefit. The third occurs when patients receive appropriate medical services, but those services are provided badly, exposing patients to added risk of preventable complications.
Extensive research has documented that all three forms of clinical quality problems—underuse, overuse, and misuse—are ubiquitous in American medicine and deserve urgent attention.Substantial underuse of effective interventions pervades the delivery of preventive care, acute care, and chronic care; it occurs across age groups, reimbursement schemes, geographic regions, and sites of care.Studies of misuse in medicine have focused on errors made in the hospital. One subset of such errors includes those in which patients are injured as a result of negligence.Probably more important as a cause of overuse is the fact that physicians are often overly enthusiastic believers in the value of the services they provide. Over the past several decades the number of available medical and surgical interventions has increased exponentially. Because physicians derive a great deal of satisfaction from believing that they are able to do good, these newly developed interventions are commonly used in the absence of good evidence to support their efficacy.In addition, American patients are activists and expect their doctors to “do something” about their complaints.
People are also infatuated with technology, often believing that whatever is the newest must be the best. It is therefore often difficult and time consuming for physicians to convince patients that the best treatment for them may be to avoid tests, procedures, and medications and to instead rest and let some time pass. Furthermore, doctors may fear that if they do not act and something unexpected goes wrong, patients may sue.
After reading over some of the problems with care, I also read through some articles that spoke on the improvement of care. It made me think that american car makers, banks and manufactures of consumer electronics have all made emormous improvements in the quality of their products and services in the past ten to fifteen years, so does that mean we can expect the same evolution in health care? Personally I believe we hvae to over come certain obstacles that stand in the way.
Improving quality begins by defining excellent care for a condition or problem, a task that requires marshaling evidence from the research literature about the effectiveness of various treatments, adding expert judgment to the limited evidence base, and distilling this knowledge into clinical practice guidelines, detailed statements about what should and should not be done.20 Guidelines must be put to work to measure current practice. Then we must define shortfalls in quality, ascertain their causes, design and implement interventions and assess their impact, and sustain and enhance improvements.
Another obstacle is the difficulty of justifying the substantial expenditures the effort requires to chief financial officers as investments that are highly likely to produce financial returns. In short, the “business case” for quality improvement in health care is elusive. This predicament would be unfamiliar to those in business who have used a variety of techniques to improve quality and profitability at the same time. Most businesses have strong and consistent financial incentives to improve the quality of their products and services but
the same does not happen so uniformly in health care.
Another obstacle we face is a lack of demand for improvement. One might argue that even if broad-scale quality improvement cannot be supported by convincing return on investment calculations, it might be undertaken if consumers and their representatives were clamoring for it. Despite the volume of data documenting serious health care quality problems and the harm they do, providers experience little demand from consumers for substantial improvement in performance. Although consumers express concern about quality in general, the large majority rely on friends and family to recommend doctors and hospitals; they do not demand that providers produce evidence of better clinical quality or better health outcomes.
In conclusion, Some benefits fewer errors, improvements in the delivery of effective care, and reductions in unnecessary services are within the grasp of the comprehensive improvement effort we envision. Other benefits such as enhanced revenue, and increases in market share are not guaranteed. The time for consumer and providers need to step forward is now in order for changes to be made and obstacles to be knocked over.
1.www.abms.org/who_we_help/physicians/improving_quality.aspx
2.books.google.com › Medical › Administration
3.http://www.youtube.com/watch?v=nPdLqI_UPuI
Extensive research has documented that all three forms of clinical quality problems—underuse, overuse, and misuse—are ubiquitous in American medicine and deserve urgent attention.Substantial underuse of effective interventions pervades the delivery of preventive care, acute care, and chronic care; it occurs across age groups, reimbursement schemes, geographic regions, and sites of care.Studies of misuse in medicine have focused on errors made in the hospital. One subset of such errors includes those in which patients are injured as a result of negligence.Probably more important as a cause of overuse is the fact that physicians are often overly enthusiastic believers in the value of the services they provide. Over the past several decades the number of available medical and surgical interventions has increased exponentially. Because physicians derive a great deal of satisfaction from believing that they are able to do good, these newly developed interventions are commonly used in the absence of good evidence to support their efficacy.In addition, American patients are activists and expect their doctors to “do something” about their complaints.
People are also infatuated with technology, often believing that whatever is the newest must be the best. It is therefore often difficult and time consuming for physicians to convince patients that the best treatment for them may be to avoid tests, procedures, and medications and to instead rest and let some time pass. Furthermore, doctors may fear that if they do not act and something unexpected goes wrong, patients may sue.
After reading over some of the problems with care, I also read through some articles that spoke on the improvement of care. It made me think that american car makers, banks and manufactures of consumer electronics have all made emormous improvements in the quality of their products and services in the past ten to fifteen years, so does that mean we can expect the same evolution in health care? Personally I believe we hvae to over come certain obstacles that stand in the way.
Improving quality begins by defining excellent care for a condition or problem, a task that requires marshaling evidence from the research literature about the effectiveness of various treatments, adding expert judgment to the limited evidence base, and distilling this knowledge into clinical practice guidelines, detailed statements about what should and should not be done.20 Guidelines must be put to work to measure current practice. Then we must define shortfalls in quality, ascertain their causes, design and implement interventions and assess their impact, and sustain and enhance improvements.
Another obstacle is the difficulty of justifying the substantial expenditures the effort requires to chief financial officers as investments that are highly likely to produce financial returns. In short, the “business case” for quality improvement in health care is elusive. This predicament would be unfamiliar to those in business who have used a variety of techniques to improve quality and profitability at the same time. Most businesses have strong and consistent financial incentives to improve the quality of their products and services but
the same does not happen so uniformly in health care.
Another obstacle we face is a lack of demand for improvement. One might argue that even if broad-scale quality improvement cannot be supported by convincing return on investment calculations, it might be undertaken if consumers and their representatives were clamoring for it. Despite the volume of data documenting serious health care quality problems and the harm they do, providers experience little demand from consumers for substantial improvement in performance. Although consumers express concern about quality in general, the large majority rely on friends and family to recommend doctors and hospitals; they do not demand that providers produce evidence of better clinical quality or better health outcomes.
In conclusion, Some benefits fewer errors, improvements in the delivery of effective care, and reductions in unnecessary services are within the grasp of the comprehensive improvement effort we envision. Other benefits such as enhanced revenue, and increases in market share are not guaranteed. The time for consumer and providers need to step forward is now in order for changes to be made and obstacles to be knocked over.
1.www.abms.org/who_we_help/physicians/improving_quality.aspx
2.books.google.com › Medical › Administration
3.http://www.youtube.com/watch?v=nPdLqI_UPuI
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