Fine-tuning materials management in the health-care industry

Exploring the benefits of standardizing your inventory management system all the way to the supply closet

As the ramifications of the world financial crisis become more apparent, businesses, institutions and organizations are taking stock of how they operate in an effort to cut costs and cope with budgetary problems. Those who depend, in part, on endowment income, including hospitals and health-care organizations, as an example of a major segment in the service industry, have less money to work with and are hard-pressed to maintain standards with shrinking budgets. By fine-tuning their materials management, they can save money and also serve as an example for a wide variety of businesses and institutions.

Virtually every hospital, medical center, and ambulatory clinic has a materials management department that is responsible for receiving supplies, maintaining a central inventory, and delivering supplies throughout the organization. Unfortunately, this is usually where the scope of the materials management department ends.

A closer look into a nursing unit, OR suite, or exam floor reveals a smaller, self-managed inventory in supply closets, nurses' stations, and individual rooms. Although this is often necessary to keep supplies readily available at the point of use, the burden of maintaining the supply falls on the nurse and detracts from his or her primary job function: providing patient care.

Every patient-care area is unique within an organization and has different supply requirements based on the types of patients being seen, the level of care being provided, and even provider preference. Expecting a materials management organization to understand patient and provider needs may be a tall order, but with a historical look at what an area uses, and input from clinical staff, an inventory management system that extends all the way to the point of care is not out of reach.

True demand for supplies

The challenge in extending the control of a materials management department is mainly in understanding the true demand for supplies from each patient-care area. Nurses order supplies when they "feel" like they need more, or when inventory "looks low," because they lack the tools to understand when the inventory is actually running low.

Applying lean principles to get rid of waste and organize can help clarify the situation by removing materials that are not needed to provide patient care and creating standard locations for supplies so there is no "hidden inventory" in closets and cabinets.

Unfortunately, the question of how much to keep on hand remains. To create a guideline, use the historical ordering patterns of the area. Orders might come grouped in large numbers on a weekly basis, but the unit volume can be used to understand the daily demand of the area. Keep in mind that demand numbers need to be vetted with the clinical staff to make sure they are realistic.

Once a daily demand has been established, a "par level" can be defined based on the organization's preference for frequency of replenishments and tolerance for stock-outs. The inventory locations can then be labeled with the type of supply and the par level, so anyone walking into a supply closet or opening a cabinet can quickly assess which supplies are running low.

As supply locations become standardized, individual units and patient-care areas will no longer have outlandish supply requirements that materials management cannot understand; rather, it becomes just another inventory location with part numbers and par levels that need to be maintained.

Inventory turns increase as levels are changed to reflect demand, and outdated material is virtually eliminated as FIFO strategies that are applied in warehouses are brought to the unit level. An expediter can assess inventory levels on a regular basis and place orders on behalf of the unit, removing this responsibility from the nursing staff. Changes in demand can be quickly addressed because orders are based on usage rather than gut feeling, and the materials management department can adjust par levels and order quantities appropriately.

Setting inventory schedules

This standardization can result in improved efficiency, as set schedules are established for inventory counts and replenishment. Rather than delivering to every floor every day, inventory levels can be set to accommodate a strategy of defined order and delivery days for each area. This strategy should account for area proximity and supply commonality to reduce overall delivery time for each expediter.

The extension of materials management into clinical areas also has implications for central inventory. As order quantities and timing become more predictable, inventory levels in the central stores can be driven lower. Central stores no longer have to be prepared for large orders that could come in at any time; instead, they can expect orders that arrive at standard intervals for known quantities. The inventory manager will have better insight into the organization's needs and be able to set par levels accordingly.

More sophisticated organizations take this practice a step further and use it as an enabler for vendor-managed inventory. Either in the central stores area or within the clinical space, a clearly defined inventory management strategy for each supply allows strategic suppliers to manage their own inventories, greatly reducing inventory levels throughout the organization and reducing the demand for materials management personnel.

Inventory levels in hospitals or any organization can be enhanced by studying the warehouse or central storing area more closely. Delivery times can be improved by determining which departments should get their deliveries at different times during the day, taking into consideration that the last shipment of the day should be appropriate for the next morning's needs.

If the health-care provider can reduce its inventory of medical and other supplies, it will improve its cash flow; if lower-paid employees can manage the inventory instead of highly paid staff, money can be saved.

Instead of having nurses manage the inventory, materials management personnel using bar-coding and automated dispensing machines can manage more expensive unit-price items, such as medicines. Replenishment cycles can be further improved by using interchangeable drawers in storage containers to replace expensive workers.

As health-care budgets swell and patient demand increases, it's increasingly important for health-care organizations to focus on the effective use of their resources. Increasing the scope of the materials management organization is a relatively easy way to improve resource utilization: nurses spend more time delivering patient care, the materials management staff can better plan its work to meet the needs of clinical areas without increasing FTEs, and the organization's financial resources are no longer tied up in high and hidden inventory.

Why nurses will require a stronger back in 2012: Six key challenges facing the nursing community (Part 2)

4. Removal of scope of practice barriers

All the advanced degrees and residency training in the world won’t change nursing much or help us meet the growing demands for care unless we eliminate the regulatory obstacles that currently hinder nurses from practicing fully according to their educational capabilities. Do you know of any other profession where professionals are not allowed to practice to the full extent of their skills, abilities and education? Advanced practice nurses must be allowed to act as full partners in health assessment, treatment and care of patients. This is the top recommendation of the Institute of Medicine Report on the Future of Nursing, and should be supported fully by all schools of nursing, nursing organizations, nursing students and other coalitions. States must reform scope of practice regulations to ensure that advanced practice nurses are defined as primary care providers and are thus eligible for clinical and admitting privileges, are accessible to patients through the new state health insurance exchanges (launching in 2014) and are eligible for payment with private health plans as well as Medicare and Medicaid. Now is the time for this to happen, as physician shortages, an aging population and demand for more and better services strain our healthcare system. Nurse practitioners and other specialty care nurses are the answer to this growing concern, but only if they are freed of existing scope of practice limitations and able to act in accordance with the demand and their capabilities.

5. Putting science into practice

Evidence-based practice has been recognized as the "gold standard" of care by the healthcare community, as it attempts to combine the best available evidentiary research with the most appropriate care for the patient’s individual needs. However, nurses have been challenged to implement such practice by barriers due to lack of time, lack of access to the most appropriate research, failure of organizations to adopt a culture conducive to evidence-based care, and lack of nursing autonomy. Hospitals and schools of nursing must find paths to overcome these barriers and put easy-to-follow steps in place which support evidence-based practice.

At UCLA, for example, the School of Nursing and the Ronald Reagan UCLA Medical Center have collaborated to establish a director of evidence-based practice position, designed to institute a structure to engage staff nurses and other clinicians in the constant process of examining their practices to ensure they are backed by the best available scientific evidence. This includes supporting nurses in original research, bringing the findings of relevant studies to the attention of nurses, and helping nurses institute important research-based practice changes at the hospital. This program has facilitated any number of improvements. For example, based on findings that thoracic surgery patients were not consistently prepared for their post-operative experience, one nurse developed a DVD for patients and their families, greatly relieving post-op anxieties and reducing unnecessary readmissions. Tools like this not only improve patient care, but reduce healthcare costs for everyone and further demonstrate the critical role that nurses can play in our evolving healthcare system.

6. Shortage of nursing school faculty

Faculty shortages at nursing schools are limiting student capacity at a time when the demand for nurses is skyrocketing. U.S. nursing schools turned away more than 67,000 qualified applicants from baccalaureate and graduate nursing programs in 2010 due to an insufficient number of faculty, clinical sites, classroom space and budgetary and other constraints. While the American Association of Colleges of Nursing is leveraging its resources to address this issue through focused media attention, data collection and the procurement of federal funding for faculty training programs, we must all focus attention on this crisis by making sure our nurse faculties have the appropriate support and resources they need to not only prevent job burnout, but to encourage potential retirees to stay on the job longer. And, we must continue lobbying policy makers and the Federal government to act swiftly to help fund new faculty recruitment and training.

These challenges nurses face are not for the faint-of-heart, or for those without conviction. Since, there are no other profession more capable of meeting tough challenges than nursing. Our specialty was built by individuals who have broad shoulders, a strong back and perseverance. Nurses will, as they have done always, continue to transform healthcare in ways that will have an immeasurable impact on the nation’s health.

Why nurses will require a stronger back in 2012: Six key challenges facing the nursing community (Part 1)

1. Facilitating advanced education and a culture of learning

Not so long ago, earning a Licensed Practical Nurse (LPN) certificate was considered adequate training for most nurses. But today, with medical knowledge and medical technology increasing exponentially year after year, it is no longer adequate. According to the National Advisory Council on Nurse Education and Practice’s 2010 report to the U.S. Department of Health and Human Services, the medical knowledge base that had previously been doubling every five to eight years is expected to begin doubling every year. Nurses simply will not be able to keep up without advanced education and a system supporting lifelong learning.

Today’s advanced degree programs offer many opportunities for nurses, from master’s and PhD programs to specialized clinician training in fields as diverse as oncology nursing, cardiac nursing and genetics. These programs not only provide a deeper foundational understanding of clinical work and the issues affecting healthcare delivery, but they offer broader career paths, the chance to practice more independently and obtain better salaries. Yet in 2010, only 41% of nurses had bachelor’s degrees and far fewer – 12% – had master’s degrees.

Attracting more nurses to advanced degrees is a profoundly important goal and one that all academic institutions should work toward. We can do this by :

• Fostering a culture of lifelong learning through nursing organizations, schools of nursing, health care organizations and healthcare media.
•  Promoting the benefits of advanced degrees to nursing students, including better choices of jobs, higher salaries, broader career path opportunities, and better patient outcomes.
• Expanding the available number of slots for students in advanced degree programs. Many schools are hampered by too few slots for too many eligible and eager students.
• Facilitating access to advanced degree learning through online RN to BSN education modules or evening, after-hours programs.
•  Facilitating access to advanced degree funding through scholarships, tuition reimbursement programs, nurse association grants and Federal grants.
• Establishing a firm timeline by which a bachelor’s degree will be the new minimum required to practice nursing. The Future of Nursing Campaign has designated that we try to reach a goal of 80% of nurses having a baccalaureate degree by 2020. All believe that horizon is too far off, and that we must exceed the goal before 2020 in order to meet the demands on medical field. The American Association of Colleges of Nursing (AACN) will, by 2015, require a mandatory doctoral degree for those who wish to become advance practice nurses.

By implementing these changes, we can be sure that the nurses of tomorrow are properly trained with the broad knowledge and skills they will need to best serve their patients and achieve the best outcomes.

2. Development of a National Nurse Residency (Transition-to-Practice) Program

With healthcare reform, hospitals and other health providers are being asked to meet extraordinary demands for better care at a lower cost. In the new regulatory environment, hospitals will be expected to take on more accountability, improve outcomes and better address costly critical and acute care. In many cases, reimbursement will shift to a fee-for-performance model and a hospital’s financial success will depend, at least in part, on its ability to prevent hospital-acquired conditions, reduce unnecessary readmissions and meet rigorous pre-determined metrics. In this environment, hospitals will be demanding the highest caliber nurse professionals with in-depth clinical practice experience, specialization in key areas such as oncology and geriatrics, proficiency with new technology, and the ability to work effectively with colleagues in case management and across all departments.

To keep pace, nursing programs have established accelerated nursing programs to quickly get nurses into practice. But we must do more than simply get nurses out on the floor. We must ensure that they are properly prepared to perform the complex, fast-paced and often overwhelming tasks found in the actual hospital setting. We must assure the safety of every patient by establishing universal nurse residency programs, to begin immediately after the completion of a nursing degree or before transitioning into a new area of clinical practice. This is not a new idea. Schools of nursing and hospitals have been working for years to get such programs into place, but they are costly, and many have been abandoned due to lack of funding and an absence of advocacy by opinion leaders and policy makers. Nurse leaders must continue to rally schools of nursing, nursing coalitions, state boards of nursing, appropriate credentialing organizations and the Federal government to determine a clear path for the development, funding and implementation of these programs.

3. Increased diversity and transcultural/transgenerational training

As our population shifts to include more minorities and as the number of seniors and centenarians doubles and triples, nurses must be better prepared to communicate in more languages, and to better understand a range of cultural and aging issues. At universities like UCLA School of Nursing, not only do we continue to diversify our faculty, students and staff to ensure a true transcultural nursing school, but we also send our students and faculty researchers to other areas of the world to broaden their depth of understanding of culturally sensitive care and to collaborate on key health issues in developing nations. Through an international exchange of ideas and research collaborations, nurses are addressing important health challenges and pushing the scientific and medical boundaries as never before. The results include research collaboration on everything from smoking cessation to HIV/AIDs, the establishment of new international scientific conferences and expanded opportunities for Federal and international grants. Ultimately, the true winners are our patients, as our increasingly global perspective translates to better care for all.

Top 5 Tips To Become A Happier Nurse

Are you feeling sad, bored and gloomy? Do you think that you’re having the worst day of your life? If you answered a resounding “YES” for both, then read these 5 easy-to-follow tips below to make yours a better and brighter day:

1. Exercise your worries away

Who says nurses are excused for daily work-outs? You may always be busy doing your daily tasks but that shouldn’t excuse you from stretching those  lazy muscles. If you think you’re not that fat to do the daily exercise, then just  do it to make you a happier nurse. According to scientific research, regular physical activity improves mood and the way we feel about ourselves. Exercise reduces depression and anxiety and helps us manage stress better. It releases endorphins into the body that promote a feeling of happiness and contentment.

2. Decide to be happy

You don’t owe anybody or anything your own happiness so the moment you wake up each morning, it would be better if you just choose to seize the day and put a smile on your face. In addition to that, happiness is a contagious emotion so if you want your patients to feel the same way about their selves, choose to be happy inside and out. We all have our good and bad days so if you are feeling low, don’t you ever forget the first reason why you became a nurse: to take care of your patient no matter what. Decide to be happy and it will not be long before you can notice that your grumpy tendencies is slowly fading away.

3.  Look at the glass half-full

Are you overworked but underpaid? Be thankful instead that you still have a job. Are you frustrated with your ill-tempered patient? Just be grateful that you have the opportunity to grow and learn the value of patience. Though we can’t turn things around us into what we really desire them to be, life still has many wonderful things to offer and all we need to do is to take them as they come and make the most out of it. You can complain all your life and still end up being miserable so why not just choose to look at the brighter side of life and discover things hidden from your naked eyes? After all, it’s not the burden that makes life miserable, it is how you carry it.

4. Count your blessings

It sounds a bit cliche but you should always remember that it’s how you value things around you, not how many things you possess, that makes you really happy. As a nurse, you have a lot of things to be thankful about: your expensive nursing education, your very supportive loved ones, your appreciative doctors and patients, and that rare opportunity to make a difference in the lives of each people you meet on a daily basis. As a tip, keep a gratitude journal or remind yourself of one small thing you were proud of or made you feel good. You will be surprised on how little things can brighten up your day.

5. Learn to let go

It’s given that difficult patients, doctors, or coworkers are normal challenges in a nurse’s life. There are those who might brought you pain in the past but how you will react to all these kind of adversities is all up to you. Nursing is a rewarding and challenging career at the same time but don’t fret because you will learn how to embrace these challenges in the long run. For now, it wont harm if you just take one baby step at a time and accept that no matter how hard you try, Nursing will never be the “perfect” playground for those who are weak at heart.

Nursing Shortage May Be Easing

The number of young people becoming registered nurses has grown sharply since 2002, a trend that should ease some of the concern about a looming nursing shortage in the United States, according to a new study.

The number of people aged 23 to 26 -- primarily women -- who became registered nurses increased by 62 percent from 2002 to 2009, approaching numbers not seen since the mid-1980s. Combined with the fact that registered nurses today tend to enter training at older ages than a generation ago, these new entering cohorts are projected to become the largest group of nurses ever observed, according to researchers from the RAND Corporation, Vanderbilt University and Dartmouth College.

The surge reverses a pattern first observed in the early 1980s of fewer young women entering the nursing profession as other career opportunities expanded. The findings are published in the December edition of the journal Health Affairs.

"The spike we've seen in young women becoming registered nurses is dramatic," said David Auerbach, the study's lead author and an economist at RAND, a nonprofit research organization. "If the trend continues, it will help to ease some of the concerns about future nursing shortages."

A decade ago researchers predicted that the United States could face a shortage of 400,000 registered nurses by 2020 because fewer young people were entering the profession. Between 1983 and 1998 the proportion of the registered nurse workforce under age 30 dropped from 30 percent to 12 percent, while the average age of working nurses increased from age 37 to 42.

Researchers evaluated the latest trends in the nursing workforce by examining information about the employment of registered nurses from 1973 to 2009 from the Current Population Survey and the American Community Survey, two large surveys sponsored by the U.S. government. Additional information from the U.S. Census Bureau also was used.

The study found that while the number of registered nurses aged 23 to 26 peaked at more than 190,000 in 1979, it fell to fewer than 110,000 by 1991 and remained low throughout the following decade.

However, since 2002 the number of young registered nurses has grown at a rate not seen since the 1970s. The number of registered nurses aged 23 to 26 has climbed from 102,000 in 2002, to 165,000 by 2009.

If the number of people entering nursing continues to grow at today's levels, researchers say that by 2030 there will be enough registered nurses to fully meet the nation's projected needs. If that entry plateaus, however, the workforce will barely keep pace with population growth - which would likely result in continued shortages.

"These findings were a real surprise and are a very positive development for the future health care workforce in the United States," Auerbach said. "Compared to where nursing supply was just a few years ago, the change is just incredible."

Researchers say there are several reasons that interest in nursing has surged. Several major initiatives were launched to increase interest in nursing careers. Meanwhile, nurse training programs expanded enrollment and created innovative efforts that allows some people to get training on an accelerated schedule.

In addition, the economic downturn and a continued decline in manufacturing jobs has reduced many of the career opportunities that had attracted young people who otherwise might choose nursing.

To Keep Nurses, Improve Their Work Environments

Nurses working in hospitals around the world are reporting they are burned out and dissatisfied with their jobs, reported researchers at the University of Pennsylvania School of Nursing's Center for Health Outcomes and Policy Research in a study of 100,000 nurses in nine countries.

Between 20 to 60 percent of nurses reported symptoms of burnout according to the study, published in the International Journal for Quality in Health Care, which collected data from nurses in more than 1,400 hospitals to determine the effect of hospital work environments on hospital outcomes.

"The percentage of nurses reporting high burnout was over a third in most countries and decidedly higher in South Korea and Japan, near 60 percent in both countries," said lead authors Linda Aiken, PhD, RN, director of the Center for Health Outcomes and Policy Research at Penn Nursing. "Job dissatisfaction varied from 17 percent in Germany to around a third of nurses in most countries and a high of 60 percent dissatisfied in Japan. Almost half of nurses in all countries, except in Germany, and many more than half of the nurses in a few of the countries, lacked confidence that patients could manage their care after discharge," said Dr. Aiken.

Hospitals with better work environments had lower burnout, lower likelihood of job dissatisfaction and a decrease in reports of little or no confidence of discharge readiness of patients. In hospitals with poor work environments the percentage of nurses who believed patients were not prepared for discharge ranged between 22 percent and 85 percent.

"How well nurses are faring in their jobs has been found to be a barometer of how well patients in those same hospitals are faring," said Dr. Aiken. "In all countries, more than one in ten nurses report that care is either fair or poor, and in three of four Asian countries studied, nurses' ratings of fair/poor care are much more frequent."

The nine countries that participated in the study were: China, South Korea, Thailand, Japan, New Zealand, Canada, Germany, the United Kingdom, and the United States.

Dr. Aiken and her colleagues point to hospital leaders and policy makers to improve the nurse workforce and quality of care by increasing staff, improving nurse and physician relations, involving nurses more in hospital decisions, and greater managerial support of those who provide clinical care at the bedside.

"Increased attention to improving work environments might be associated with substantial gains in stabilizing the global nurse workforce while also improving quality of hospital care throughout the world," said Dr. Aiken.

Using measurements developed by Dr. Aiken and colleagues, researchers tracked nurses' responses to questions about staffing-resource adequacy, nurse manager ability and leadership, nurse-physician relations, nurse participation in hospital affairs, and nursing foundations for quality of care.

4 industry issues plaguing healthcare CEOs in 2012

Recently, the Huron Consulting Group released its report, “Leading Through Transformation:  Top Healthcare CEO’s Perspectives on the Future of Healthcare.” The report included insights from the Huron Healthcare CEO Forum and took a hard look at some of the top industry issues that will be plaguing CEOs in the year to come.

Gordon Mountford, executive vice president at Huron, recognized the challenges many healthcare CEOs are or will soon be up against. “The immense operational and financial challenges healthcare leaders are facing would be daunting for executives in any industry,” he said. “And yet, healthcare leaders across the country are stepping up to the challenge, carefully considering the way forward and developing solutions that will shape the future of healthcare delivery in our country.”

The report identified four industry issues troubling healthcare CEOs the most, and their views on how to solve them.

1. Moving from “volume to value.” According to the report, CEOs are concerned with making the new healthcare business model a reality. “Health reform initiatives are meant to push, pull and shove healthcare organizations toward delivering affordable, value-based care,” the report read. But, exactly how long will it take to transition to value-based reimbursement was a topic many of the CEOs explored further. “Let’s face reality. The government is out of money and will no longer be able to go further into debt funding healthcare,” said Christopher Olivia, SVP for Strategic Planning and New Venture Development at Highmark. “We’re in a rate/volume business model today that will not survive. We’re not going to get to the ‘new normal’ by marginal changes. We need some big ideas.”

2. Changing the care delivery model. According to the report, the industry needs to reimagine the “who, what, when, where and how” of delivering care. The report looked back to moving the industry from “volume to value” and asked CEOs to discuss challenges and visions centered on many of the core aspects needed to accomplish this transition. Many of them agreed the vast majority of hospitals aren’t configured to be providers of “wellness,” and delivering the capabilities to manage population health will require not only time, but also capital investments. “We are asking how we can better address high users of care, managing the healthcare needs that are inevitable and making them less intense and less frequent,” said Marna Borgstrom, president and CEO at Yale-New Haven Hospital. “But in the big picture, we, as a society, need to have a greater understanding of the impact investments in social infrastructure could have on public health.”

3. Aligning physicians. It’s no secret physicians play a vital role in shifting the healthcare delivery system, but, according to the CEOs, they’re still challenged when it comes to developing relationships and partnering together to drive change. According to the report, there was a general agreement that creating healthy, sustainable and mutually beneficial relationships with physicians remains “a complex, complicated and sometimes elusive goal.” “We use the Mayo dyad model to create what I call ‘healthy friction,’” said Bryan Mills, president and CEO, Community Health Network. “We have to emphasize in that pairing, it's not that one physician is solely looking at things operationally, and one looking at things solely clinically. They have to work together.”

4. Cost containment. The new healthcare business model needs to become a reality, the report read, and according to CEO feedback, most agreed on “the need to get 20 to 40 percent of costs out of the system to operate at anticipated future reimbursement levels.” It added the majority of CEOs are taking a “two-pronged” approach to cost containment: getting every non-value-added cost out of the system now, while working on implementing fundamental changes for the future. Dan Wolterman, president and CEO of Memorial Hermann Healthcare System, was quoted as saying the time of living “in two business models,” is coming to an end. “We are definitely moving toward fixed or bundled payment and away from making margin on volume,” he said. “The old strategy is quickly becoming the high cost/low margin strategy. Unfortunately, we get to run these two opposing strategies simultaneously. You can live in two business models for a while, but not forever.”

What healthcare can learn from the car industry

Too often, everyone assumes the work is being done correctly and that each person knows his or her role. Many customer-supplier relationships are undefined and dysfunctional, and caregivers generally assume they are not empowered to make changes to specific processes.

In the absence of a standard model of healthcare delivery, medical errors sneak through the cracks of the disorganized care system.

By modeling the healthcare delivery system after successful business practices, we can help prevent medical errors. Let's look at Toyota, whose Toyota Production System (TPS) uses three fundamental approaches for improving automobile manufacturing.

TPS for healthcare organizations

Set protocols: Define the work that needs to be done, how it should be done, and who is responsible for its completion. Standardize this practice for all healthcare staff and all potential diagnostic situations.

When a caregiver works with multiple physicians, they are required to learn different protocols to achieve the same goal. In the absence of a single best-practice protocol for each disorder, all processes in hospitals and clinics are random and ill-defined. When there is an error or a delay, there is no single protocol that can be modified, making lasting improvements impossible.

Identify and support customer-supplier relationships: At Toyota, the assembly line worker's most important customer is the person next in the assembly line. Physicians too often regard themselves as the customers and nurses as the suppliers of respect and ego gratification.

Following this example, physicians must identify themselves as the supplier and nurses and support staff as the customers. They need to listen closely to the concerns of bedside nurses who experience the dysfunctional delivery systems all day, every day, and then supply them with clear instructions for patient care.

Use the scientific method: Caregivers should be encouraged to implement changes by using iterative cycles of planning the change (plan), trying out the change (do), measuring the effects of the change (study), and then if deemed a true improvement, implementing the change on a broader scale (act).

Often administrators discourage adaptive change for fear of breaking a regulatory rule. A command-and-control administrative structure discourages front-line leadership and any sense of autonomy.

Those with higher administrative authority must reduce formality and flatten the power gradient, because hierarchical power structures deter open communication and increase the chance of errors. When errors do occur, the individual reporting the error should be supported emotionally, and in most cases punishment should be avoided. Those with administrative authority need to understand that most errors are the consequence of bad systems, not bad people.

TPS to improve communication and prevent errors

Treat everyone with respect. Everyone has an important role to play in managing the care of our patients. Humility, friendliness and empathy go a long way in lowering the power gradient.

Become an effective team leader. Teamwork acknowledges the value of all members of the care team and encourages reciprocal communication, that is, every idea from a team member is a good idea. Teams reduce errors because you have many eyes, ears and brains focusing on the same problems. Great teams develop a team identity that gives everyone a sense of belonging and greatly increase job satisfaction.

 Understand that in modern healthcare delivery, you as an individual will not be able to manage your patients alone. You will need to depend on fellow physicians to create shared protocols to create consistent ways of doing things.

By creating operating standards within your healthcare institution for specific diseases and problems, you will allow those working with you to be more efficient and reduce the likelihood of errors. This is not cookbook medicine, but rather the best approach for creating good habits that will free everyone to focus on events that are unexpected and which require high-level decision-making.