My QI Story: Amy Deutschendorf, MS, RN
Monday, July 8, 2019
A Nurse's Perspective to Patient Safety
Amy Deutschendorf, MS, RN
People frequently ask me if I would have done something differently with my life as it relates to career choices….and I answer with an emphatic “NO.” My background has allowed me to reinvent myself repeatedly, exploring new opportunities, learning experiences and developing skills in education, clinical practice, outcomes research and leadership. I have been faculty, a clinical nurse specialist, consultant, and health care executive as VP for Johns Hopkins Health System in care coordination. As a nurse, I have been able to reach my core goals for patient care and advocacy by influencing care delivery and health policy while facing continuing challenges in a rapidly changing healthcare environment.
From my perspective, nursing practice has always been about protecting the patient. Even as clinical faculty, the foremost priority was “is this student safe behind the curtain.” My understanding of safety processes and quality outcomes crystallized with my role as a clinical nurse specialist in medicine and oncology. Translation of new medical discoveries and technology into safe practice defined this work. Every new clinical program, such as the implementation of ventilators or new biologic therapies on medical/surgical units, came with substantial risks for patients without understanding all of the processes and unintended consequences associated with poor planning or lack of clinical competency. My appreciation of the importance of “collaborative practice” was born here. The interdependence of the healthcare team and physician colleagues as partners became my operating paradigm. Systems thinking as the foundation of patient care delivery continued to drive my work in influencing safe patient care.
As my career progressed from the bedside to hospitals and health systems, I had the opportunity to lead the transformation of acute patient care delivery into a transdisciplinary model of care coordination, through a 20 million dollar CMMI grant. This model incorporated the principles of communication, collaboration, coordination, continuity, and culture….the fundamental elements of patient and family-centered care. As our provider teams implemented new processes for acute and transitional care delivery, deliberate attention was paid to process and outcome measurement at each step. We were able to pinpoint specific processes that resulted in untoward consequences such as post-operative infections after gastrointestinal surgery. We discovered that patient and family education was a significant factor in the patient’s ability for post-discharge self-care management. While seemingly obvious, current electronic discharge instructions and individualized multi-modalities for teaching are inadequate for patients with varying health literacy, complexities of medical conditions, support at home, etc. While the Project RED research was conducted over a decade ago, remarkably little progress has been made to ensure that all patients have the tools they need to be successful in managing their care at home or to simply engage in health improvement.
Despite the work over the last 20 years since the publication of To Err is Human…it is argued by some that little improvement in patient safety has been achieved. The proliferation of pay for performance quality measures imposed on health systems and providers from the public as well as private sectors, although well-meaning, has also fragmented priorities for over-stressed and under-resourced healthcare organizations. Moreover, there may actually be increased patient risk as a result of poorly planned “quality” interventions resulting in unanticipated adverse events. Are we certain, for example, that the decreased costs related to the reduction in “potentially preventable readmissions” are not also associated with negative clinical outcomes such as worsening post-acute complications or 30-day mortality?
Crossing the Quality Chasm identified “outmoded systems of work” as the key issue impacting patient safety and quality, and determined specific goals and principles to redesign care processes. Despite this clear roadmap, barriers to successful implementation are many. The complexity of the healthcare environment continues to increase at an alarming speed with competing priorities that frequently distract us from our laser focus on process redesign and systems thinking as it relates to care delivery across the continuum.
In my opinion, it is through the collaboration of all provider representatives of the healthcare team that context and perspective can be understood to develop innovative models of care that improve safety and quality outcomes. I am thrilled to be a new member of the ACMQ and join the group of talented providers and outcomes scientists who are dedicated to moving this important work forward.