The importance of humans in health care

December 5th, 2018 / By Barbara Aubry, RN

The online portal Dictionary describes healthcare as “noun; the maintenance and improvement of physical and mental health, especially through the provision of medical services”. Interesting that it does not mention electronic medical records but the provision of medical services by humans for humans. Of course, humans also provide medical services for pups and kittens and all manner of living beings, but the operative word in the definition of healthcare is “provision.”

With this hypothesis in mind, I read with interest a recent article in Medscape titled “Inpatient Safety Linked to Nurse Work Environment.” The study surveyed RNs and patients in 535 hospitals. The study results indicated “hospitals that fail to improve the clinical work environment may be slowing their own progress toward reducing patient harm.”

The study, by Linda H Aiken, PhD et al from the University of Pennsylvania found the following:

  • In 2003, the Institute of Medicine published Keeping Patients Safe: Transforming the Work Environment of Nurses. The report contained a review of data showing that nurse staffing and work environments that supported nurses’ performance were tied to better patient safety. The report also made eight recommendations aimed at improving nursing work environments.
  • To learn how much clinical work environments have improved and whether these improvements were associated with greater advancements in patient safety, Aiken and colleagues surveyed thousands of nurses and patients at 535 hospitals in four large states at two different time points between 2005 and 2016.
  • Only 21 percent of hospitals demonstrated substantial improvement of more than 10 percent during that time. The work environment was unchanged in 71 percent of hospitals and deteriorated by at least 10 percent in 7 percent of hospitals.
  • Among hospitals that made improvements to the clinical work environment, patients’ ratings rose by 11 percent, and 15 percent more nurses said the quality of care at their hospital was excellent, compared with hospitals that did not make such improvements.
  • In the 7 percent of hospitals in which clinical environments worsened, the percentage of nurses who rated patient safety favorably dropped by 19 percent during the study, and 25 percent fewer nurses said patient safety was a top priority for management.
  • In contrast, in hospitals in which the clinical environment improved, there was a 15 percent increase in the proportion of nurses who reported excellent quality of care. Similarly, the proportion of nurse who gave high patient safety grades increased by 15 percent during the study, the percentage that said they were satisfied with their jobs increased by 16 percent, and the number that said they were not burned out rose by 12 percent.
  • Overall, 60 percent of RNs said the quality of care at the hospital where they worked was less than excellent; 68 percent rated their hospital 8 or lower on a 10-point scale (10 = excellent). More than half (54.9 percent) reported they would not definitely recommend their hospital to a friend or family member. Almost a third of RNs gave their hospitals unfavorable grades on patient safety (29.6 percent) and infection prevention (28.9 percent).
  • Of patients surveyed, 31.8 percent rated their hospital unfavorably, and 30.2 percent said they would not definitely recommend their hospital to friends and family. Fewer than one quarter of patients (23.9 percent) reported that nurses did not consistently communicate well with them, and 38.2 percent said hospital staff did not always help them quickly and did not always explain medications before administering them. Of those who needed medication for pain, 31.4 percent reported that their pain was sometimes poorly controlled.
  • Favorable patient responses increased even in hospitals in which the clinical environment deteriorated, although the favorable change was at least twice as large in hospitals in which the clinical environment had improved.

My take

These findings are not rocket science: The better the work environment, the better the quality of the work. What intrigues me is why does there continue to be a lack of focus on clinicians and their ability to provide the best and safest care for patients? It seems (to me) that healthcare’s focus is less on patients and more on the latest electronic medical record release. My intention is not to diminish the importance of communications technology in health care. But can we focus again on the basics of care by humans for humans. The humans in the building should not be overlooked when the entire facility is focused on the next go-live of the latest and greatest. Ask any patient (AKA healthcare consumer) if they prefer their nurses and doctors to focus on them rather than their tablet or phone? The answer is likely to be the same when doctors and nurses are asked if they prefer to focus on caring for patients. Pay attention healthcare industry—with the rate of clinician burnout, who will be left to enter the data and respond to that call bell? 

Barbara Aubry is a senior regulatory analyst for 3M Health Information Systems.