Collaborative Caring: Stories and Refections on Teamwork in Health Care
Edited by Suzanne Gordon, David L. Feldman, MD, AND Michael Leonard, MD
“Collaborative Caring makes a unique contribution in the scope and breadth of teamwork it considers. It is an
important book.”—AUDREY LYNDON, PHD, RNC, FAAN, UNIVERSITY OF CALIFORNIA SAN FRANCISCO
“Teamwork is the neglected part of medical training and the new frontier for reliable delivery of quality care. It’s
not enough to know what to do. Providers need to be able to deliver that care reliably—and that takes teamwork.
This book emphasizes the essential elements of real teamwork: actions coordinated by a shared goal, shared
mental model of the situation, cross-monitoring, a fat hierarchy, mutual respect, and trust. If your operating
room team or patient care team does not have these characteristics, then this book is for you.”—JOHN R. CLARKE,
MD, PROFESSOR OF SURGERY, DREXEL UNIVERSITY; CLINICAL DIRECTOR FOR PATIENT SAFETY AND QUALITY INITIATIVES, ECRI INSTITUTE; CLINICAL DIRECTOR, PENNSYLVANIA PATIENT SAFETY AUTHORITY
“Collaborative Caring tells the human side of health care through a clever collection of frank essays and personal accounts on teamwork. While it candidly acknowledges the personal, cultural, and political tribulations faced by health care teams everyday, it also inspires perseverance and fortitude by arming readers with stories that can be retold to drive meaningful teamwork in their own workplace.”—JOHN CHUO, MD, MS, CHILDREN’S HOSPITAL OF PHILADELPHIA AND UNIVERSITY OF PENNSYLVANIA
SUZANNE GORDON is coauthor of Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety and coeditor of First, Do Less Harm, both from Cornell. She is coeditor of the Culture and Politics of Health Care Work Series and was program leader of the Robert Wood Johnson–funded Nurse Manager in Action Program. David L. Feldman, MD, is Senior VP and Chief Medical Ofcer at Hospitals Insurance Company. Michael Leonard, MD, is Managing Partner at Safe and Reliable Healthcare, Adjunct Professor of Medicine at Duke University, and a faculty member at the Institute for Healthcare Improvement.
The U.S. healthcare system is now spending many millions of dollars to improve “patient safety” and “inter-professional practice.” Nevertheless, an estimated 100,000 patients still succumb to preventable medical errors or infections every year. How can health care providers reduce the terrible financial and human toll of medical errors and injuries that harm rather than heal?
Beyond the Checklist argues that lives could be saved and patient care enhanced by adapting the relevant lessons of aviation safety and teamwork. In response to a series of human-error caused crashes, the airline industry developed the system of job training and information sharing known as Crew Resource Management (CRM). Under the new industry-wide system of CRM, pilots, flight attendants, and ground crews now communicate and cooperate in ways that have greatly reduced the hazards of commercial air travel.
The coauthors of this book sought out the aviation professionals who made this transformation possible. Beyond the Checklist gives us an inside look at CRM training and shows how airline staff interaction that once suffered from the same dysfunction that too often undermines real teamwork in health care today has dramatically improved. Drawing on the experience of doctors, nurses, medical educators, and administrators, this book demonstrates how CRM can be adapted, more widely and effectively, to health care delivery.
The authors provide case studies of three institutions that have successfully incorporated CRM-like principles into the fabric of their clinical culture by embracing practices that promote common patient safety knowledge and skills.They infuse this study with their own diverse experience and collaborative spirit: Patrick Mendenhall is a commercial airline pilot who teaches CRM; Suzanne Gordon is a nationally known health care journalist, training consultant, and speaker on issues related to nursing; and Bonnie Blair O’Connor is an ethnographer and medical educator who has spent more than two decades observing medical training and teamwork from the inside.
“First, Do Less Harm is a tour de force and a must-read for those interested in improving patient safety. This book
provides a close-up view of the real work of improving patient safety. Ross Koppel and Suzanne Gordon roll up their
sleeves and pull back the covers on the important problem of patient safety, offering practical wisdom on how to improve.”
—Peter J. Pronovost, MD, Professor, The Johns Hopkins University School of Medicine, School of Public Health and School of Nursing; Medical Director, Center for Innovation in Quality Patient Care, and Director, Quality & Safety Research Group
Each year, hospital-acquired infections, prescribing and treatment errors, lost documents and test reports, communication failures, and other problems have caused thousands of deaths in the United States, added millions of days to patients’ hospital stays, and cost Americans tens of billions of dollars. Despite (and sometimes because of) new medical information technology and numerous well-intentioned initiatives to address these problems, threats to patient safety remain, and in some areas are on the rise.
In First, Do Less Harm, twelve health care professionals and researchers plus two former patients look at patient safety from a variety of perspectives, finding many of the proposed solutions to be inadequate or impractical. Several contributors to this book attribute the failure to confront patient safety concerns to the influence of the “market model” on medicine and emphasize the need for hospital-wide teamwork and greater involvement from frontline workers (from janitors and aides to nurses and physicians) in planning, implementing, and evaluating effective safety initiatives.
Several chapters in First, Do Less Harm focus on the critical role of interprofessional and occupational practice in patient safety. Rather than focusing on the usual suspects-physicians, safety champions, or high level management-these chapters expand the list of “stakeholders” and patient safety advocates to include nurses, patient care assistants, and other staff, as well as the health care unions that may represent them. First, Do Less Harm also highlights workplace issues that negatively affect safety: including sleeplessness, excessive workloads, outsourcing of hospital cleaning, and lack of teamwork between physicians and other health care staff. In two chapters, experts explain why the promise of health care information technology to fix safety problems remains unrealized, with examples that are at once humorous and frightening. A book that will be required reading for physicians, nurses, hospital administrators, public health officers, quality and risk managers, healthcare educators, economists, and policymakers, First, Do Less Harm concludes with a list of twenty-seven paradoxes and challenges facing everyone interested in making care safe for both patients and those who care for them.
The reassuring bromides of “chicken soup for the soul” provide little solace for nurses and the people they serve in real-life hospitals, nursing homes, schools of nursing, and other settings.
In the minefield of modern health care, there are myriad obstacles to quality patient care-including work overload, inadequate funds for nursing education and research, and poor communication between and within the professions, to name only a few. The seventy RNs whose stories are collected here by the award-winning journalist Suzanne Gordon know that effective advocacy isn’t easy. It takes nurses willing to stand up for themselves, their coworkers, their patients, and the public.
When Chicken Soup Isn’t Enough brings together compelling personal narratives from a wide range of nurses from across the globe. The assembled profiles in professional courage provide new insight into the daily challenges that RNs face in North America and abroad-and how they overcome them with skill, ingenuity, persistence, and individual and collective advocacy at work and in the community. In this collection, we meet RNs working at the bedside, providing home care, managing hospital departments, teaching and doing research, lobbying for quality patient care, and campaigning for health care reform. Their stories are funny, sad, deeply moving, inspiring, and always revealing of the different ways that nurses make their voices heard in the service of their profession. The risks and rewards, joys and sorrows, of nursing have rarely been captured in such vivid first-person accounts. Gordon and the authors of the essays contained in this book have much to say about the strengths and shortcomings of health care today-and the role that nurses play as irreplaceable agents of change.
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Nursing Against the Odds: How Health Care Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care
“The nursing profession lacks many things, like decent working conditions, recognition, and respect on the job. But, with Suzanne Gordon, it has something other professions can only envy-a skilled reporter, brilliant analyst, and steadfast advocate.”
In the United States and throughout the industrialized world, just as the population of older and sicker patients is about to explode, we have a major shortage of nurses. Why are so many RNs dropping out of health care’s largest profession? How will the lack of skilled, experienced caregivers affect patients? These are some of the questions addressed by Suzanne Gordon’s definitive account of the world’s nursing crisis. In Nursing against the Odds, one of North America’s leading health care journalists draws on in-depth interviews, research studies, and extensive firsthand reporting to help readers better understand the myriad causes of and possible solutions to the current crisis.
Gordon examines how health care cost cutting and hospital restructuring undermine the working conditions necessary for quality care. She shows how the historically troubled workplace relationships between RNs and physicians become even more dysfunctional in modern hospitals. In Gordon’s view, the public image of nurses continues to suffer from negative media stereotyping in medical shows on television and from shoddy press coverage of the important role RNs play in the delivery of health care.
Gordon also identifies the class and status divisions within the profession that hinder a much-needed defense of bedside nursing. She explains why some policy panaceas-hiring more temporary workers, importing RNs from less-developed countries-fail to address the forces that drive nurses out of their workplaces. To promote better care, Gordon calls for a broad agenda that includes safer staffing, improved scheduling, and other policy changes that would give nurses a greater voice at work. She explores how doctorsand nurses can collaborate more effectively and what medical and nursing education must do to foster such cooperation. Finally, Gordon outlines ways in which RNs can successfully take their case to the public while campaigning for health care system reform that actually funds necessary nursing care.
To get the resources and respect they need, nurses have long had to be advocates for themselves and their profession, not just for their patients. For a decade, From Silence to Voice has provided nurses with the tools they need to explain the breath and complexity of nursing work. Bernice Buresh and Suzanne Gordon have helped nurses around the world speak up and convey to the public that nursing is more than dedication and caring—it demands specialized knowledge, expertise across a range of medical technologies, and decision-making about life-and-death issues. “Nurses and nursing organizations,” they write, “must go out and tell the public what nurses really do so that patients can actually get the benefit of their expert care.”
The comprehensively revised and updated third edition of From Silence to Voice will help nurses construct messages using a range of traditional and new social media that accurately describe the true nature of their work. Because nurses are busy, the communication techniques in this book are designed to integrate naturally into nurses’ everyday lives and to complement nurses’ work with patients and families.
Legally mandated nurse-to-patient ratios are one of the most controversial topics in health care today. Ratio advocates believe that minimum staffing levels are essential for quality care, better working conditions, and higher rates of RN recruitment and retention that would alleviate the current global nursing shortage. Opponents claim that ratios will unfairly burden hospital budgets, while reducing management flexibility in addressing patient needs.
Safety in Numbers is the first book to examine the arguments for and against ratios. Utilizing survey data, interviews, and other original research, Suzanne Gordon, John Buchanan, and Tanya Bretherton weigh the cost, benefits, and effectiveness of ratios in California and the state of Victoria in Australia, the two places where RN staffing levels have been mandated the longest. They show how hospital cost cutting and layoffs in the 1990s created larger workloads and deteriorating conditions for both nurses and their patients-leading nursing organizations to embrace staffing level regulation. The authors provide an in-depth account of the difficult but ultimately successful campaigns waged by nurses and their allies to win mandated ratios. Safety in Numbers then reports on how nurses, hospital administrators, and health care policymakers handled ratio implementation.
With at least fourteen states in the United States and several other countries now considering staffing level regulation, this balanced assessment of the impact of ratios on patient outcomes and RN job performance and satisfaction could not be timelier. The authors’ history and analysis of the nurse-to-patient ratios debate will be welcomed as an invaluable guide for patient advocates, nurses, health care managers, public officials, and anyone else concerned about the quality of patient care in the United States and the world.
Life Support: Three Nurses On the Front Lines
“Nurses contribute greatly to the medical and emotional well-being of their patients but are often undervalued in the contemporary health care system, argues journalist Gordon (Prisoners of Men’s Dreams) in this enlightening, involving, in-depth study. She interweaves the history and philosophy of nursing with on-the-job observations of three nurses at Boston’s Beth Israel Hospital: Ellen Kitchen, a geriatric-home-care practitioner; Jeannie Chaisson, a clinical specialist, charged with giving support to bedside nurses; and Nancy Rumplick, an oncology nurse. Profiling a variety of cases the three worked on, Gordon lets the nurses speak for themselves, effectively illustrating their commitment to their profession and involving readers in real-life dramas, which often turn out to be ironic. Gordon describes Rumplick’s ability to ease the fears of chemotherapy patients even when nausea is complicated by spousal abuse; Kitchen’s dedication to her homebound clients, who may need as much help with housecleaning as with taking medication; and Chaisson’s “situational teaching,” on topics from swallowing (for stroke patients) to helping a prostate patient insert a catheter. The author sees the current trend toward managed care as a push for profits that will take precedence over patients and threaten the existence of quality nursing care.”
“A beautiful, profound, and profoundly important book. . . . Gordon’s message is simplicity itself: sick people need skilled, humane, and insightful care that keeps their interests paramount. Registered nurses have historically provided that care, but now their ability to fulfill their crucial role faces the greatest jeopardy in the history of the profession. . . . Life Support belongs in the august company of Silent Spring, The Other America, The Feminine Mystique, and other pivotal works with the power to shape the nation’s consciousness.
Bedside Manners is a remarkable teaching tool. It’s a play that helps staff reenact healthcare scenarios. In the process, everyone gains insight into the dynamics of their team communication. Why do individuals behave as they do? How can individual healthcare members learn to constructively collaborate?
Bedside Manners is ideal for any healthcare team that is working to create a respectful, collaborative patient care environment. Past participants have reported that the insights gained using Bedside Manners have contributed to increased job satisfaction, team communication and better patient care.
Bedside Manners creates a safe environment to address the tensions that can arise in patient care. The material can be completely customized to any healthcare setting. The insights team members gain can significantly improve job satisfaction and performance.