Sunday, October 6, 2013

Systems Improvement

I'm taking a project planning class in my MS program in Nursing (I love public health, I love nursing so I'm doing Advanced Practice Public Health Nursing). I'm a Public Health Nurse, as you know (it's in the blog name ;) in case you missed it. That means I take a public health perspective to nursing and assist individuals to navigate through our health system, which is populations based. The people who design the system is not necessarily the people who use the system. I like this quote by Dr. Robert Wachter:                   
In the old days — before the modern patient safety movement — nobody thought much about systems, and the fundamental problem was blaming individuals when bad systems were at fault. That was wrong, and got us nowhere in our quest to keep patients safe.

But [now] we do have some pretty good systems for preventing errors, systems that can always be subverted by recalcitrant providers. In such circumstances, the failure is not that of the system but that of the individual, and I believe they should be handled accordingly.
Getting this balance right is really tricky, as many of the dozens of comments in response to the Levy blog, as well as the Boston Globe article on the case, illustrate.
I don't think that we've gotten that right in many of our healthcare systems. Particularly those involving substance abuse, mental health, and poverty. I think we still blame individuals too much versus looking on how we've built our society as a system, education, jobs, and healthcare and then blame individuals living in poverty for their lack of education, jobs, and money. Isn't that backwards? I'm a big advocate for changing the way things are done and I think PHNs are one of those few great resources that teach individuals how to take control of their healthcare. If you want to learn more about Quality Improvement in Healthcare check out this free certificate program from IHI.

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