Editor's
Note
Make
the best of it
Identifying
and developing best practices ensures quality care
Beth Ulrich, Ed.D.,
RN, Texas Editor
November
13, 2000
Our
continuing education article in this issue, "Aim
High: Best practices improve patient care," provides
an overview of best practices. And it’s a concept that really
works.
Brent
James, an outcomes management expert, has said that to improve
patient outcomes and reduce costs, "find and implement
the best" is a more effective strategy than "find
and eliminate the worst." That’s what best practices
are all about.
Sometimes,
one of the most difficult things about best practices is
finding them – not because they don’t exist, but because health
care professionals tend not to recognize what they do well.
When you tell them that they do a good job, they often don’t
even hear the compliment as they rush off to do something
else. If their work is identified as a best practice and
they’re asked how they achieve that outcome, they may not
know. "That’s just how we do it" is a frequent
response, making a challenge of determining what contributes
to their best practice.
There
are big best practices and small best practices. Regardless
of size, generally only a few key levers determine whether
each best practice occurs. For example, one organization
for which I worked determined that the key lever for patients
in a certain surgical diagnosis achieving best practice
outcomes and length of stay was how quickly treatment was
initiated. All the other variables and tasks paled in comparison
to this one event.
In another
case, we found that if we were successful at "hand-offs" – giving
complete and timely information anytime a patient was transferred
from one caregiver to another, one department to another
or one organization to another – we consistently obtained
best practice results. When we didn’t do the hand-offs well,
the patient outcomes were not as good and we repeated a
lot of work, procedures and tests.
The
concept of identifying the key levers also allowed us to
prioritize staff time. In a time crunch (And when are we
ever not in a time crunch?), the best practice key levers
were done first.
Are
there key levers in identifying and developing best practices?
Absolutely. First, everybody has to play. Best practices
are a team game. No one group/profession can act alone.
Every group that is or will be involved in achieving the
best practice must be at the table from the beginning. As
Casey Stengal once said, "It’s easy to get the players.
Gettin’ them to play together, that’s the hard part."
Next,
there must be agreement that the good of the whole outweighs
the good of the few. Territoriality is out-of-bounds. Third,
there must be an understanding that the process never ends.
The practice that is best today will have to be continuously
improved to remain best.
Finally,
there must be support from management. Best practice work
takes time. The outcomes are well worth the investment,
but shorting the process will guarantee failure.
Best
practices really do work. Patients have better outcomes.
We spend less money. We make the best use of our time. We
recognize and celebrate our successes. It doesn’t get much
better than that.
