Promoting Clinical Excellence: Role Of Health Service And Health Care Team In Improving Patient Safety And Quality Of Care

Purpose and search strategy for literature search

Discuss aboout the Promoting Clinical Excellence.

Health care professional have the duty to effectively deliver quality patient outcome. They are required to promote patient safety and quality through a culture of safety, evidence based practice and clinical judgment (Longtin et al. 2010, pp. 53-62). However, this process of safety is compromised due to fatigue and burnout in the job.

To complete explore the issue of burnout in health care, relevant literature on the topic was searched from Google Scholar, Cinahl, MedLine, PsychINFO and Cochrane Library. The key search term included ‘burnout’, ‘stress in health care’ and ‘burnout and patient safety. Only  those article were included which was published within the year of 2007 to 2017. The literature search revealed that the prevalence of burnout and psychological distress is a major issue for nurse and health care. The report explains in detail the role of health professionals and other health care team in promoting safety of patients and delivering quality care. As the main focus is on level of fatigue or burn out as an indicator of patient safety, the report discusses the experience of patients related to high burn out issues in health care staffs. Secondly, through relevant literature, it describes the risk assessment procedure and surveillance in relation to the level of burnout in nurses and the role nurses play in improving the care experience.

Health care service is a system of care where skilled clinicians and inter-professional health care team work together to improve well-being of patients and assist them in recovery and independence. The main priority of delivering care is to promote optimal level of well-being in client (Carayon et al., 2014). They have the responsibility to develop a culture of safety to improve the provisions of patient safety and deliver high quality care. Safety culture is dependent on performance and attitude of clinicians and nurses in care such as their attitude of maximizing well-being of patients and avoiding errors as far as possible. It is also dependent on organizational factors such as providing adequate training skills to health care professionals from time to time to update them with current development in medical science and intervention (Weaver et al. 2013). Safety culture can also be personified by the shared values, beliefs and implementation of appropriate procedure related to patient safety. Such beliefs and norms have an impact on the attitudes of clinicians and staffs related to patient safety and enhances their motivation to engage in safe behaviors in daily practice (Morello et al. 2013).

Role of health service and health care team in improving patient safety and quality of care

With the rise in demand of health care service and increase in complexity of the illness, many issues are faced by clinicians in the safe delivery of care. Often too many task at hand leads to errors when nurses or clinicians fail to give adequate time to patients. However, lack of adequate staffs and heavy workload creates fatigue and burnout among patients. Work stress not only contributes to high turnover rate and absenteeism, it also affects the quality of care. This causes risk to patient safety too (Leiter 2015, pp.223-227). In such situation, use of electronic medical record (EHR) has also been encouraged by health care service to enhance patient safety and quality of care. (Middleton et al. 2013) has reported that EHR provides health providers with access to complete and accurate information of patients and it maximizes the ability to diagnose disease and improve patient outcome at a fast pace. It also stores all the informations gathered by a primary care providers and clinicians dealing with the patient in emergency department can easility identify life threatening allergies or other complication in patients. With this detail, the emergency staff can work to adjust and treatment process appropriate and avoid medical errors. In some care, EHR also identifies safety problems or health issues within the system to mitigate serious consequence to patients during health care delivery (Slight et al. 2015). Hence, along with a patient safety culture, meaningful of electronic health record also provides health care team to better engage safe and quality health care practice.  

High level of burnout has been directly associated with increase in patient’s dissatisfaction with care. A study with nurse working for longer hours revealed high level of burnout among nurses and patients dissatisfaction with care increased in such situation. Nurses are at risk of burnout when they have to work overtime along with longer shifts. Rotating shifts between day and night increases the risk of fatigue and burnout in nurses. This is highly associated with nurse’s intention to leave the job and poor nursing performance (Cañadas-De la et al. 2015).

For an individual nurse, burn out leads to demotivation, emotional exhaustion and poor performance in staffs. Apart from job dissatisfaction and high nursing turnover rate, burnout is also significantly increasing the patient’s dissatisfaction with care. This is because shift timing of nurses and patients outcome have interrelation. Burnout becomes a threat to patient safety when depersonalization among nurses leads to poor engagement with patients. There is more chances of detachment from work which further lead to the development of negative attitude towards patients. All this factors result in patient dissatisfaction with health care service. The literature study showed that increase in patient dissatisfaction was high when larger number of nurses worked more than 13 hours (Stimpfel et al. 2012, pp.2501-2509). Hence, this evidence suggest that patients are less satisfied with care due to burnout issues in nurses.

Patient experience related to indicator

High-level of burnout was also associated with more incidence of medical error which posed risk to safety of patient. One study suggested that burnout was associated with lower patient safety grade and increase in therapeutic errors (Hall et al. 2016). Another study gave the indication that burnout among nurses has an impact on patient safety and proportion of patient adverse events. The cross-sectional survey with nurses regarding the work environment quality of care, job outcomes and patient adverse events showed that exhaustion along with depersonalization is an important predictor of nursing performance, quality of care and patient outcomes. To avoid creating situations that unnecessary exposes patients to quality and safety related issues, it is necessary to improve the work environment of nurses and reduce their burden in task (Van Bogaert et al., 2014).

To address the problem of burnout and its risk to patient safety, there is a need to think of strategies to mitigate the issue in clinical practice. The first step is to assess the level of burnout This can be done by means of tools like Maslach Burnout Inventory (MBI) and the Copenhagen Burnout Inventory (CBI). MBI is a psychological assessment tool used to predict burnout and the validity of the instrument is proved by various research. It uses three scales to measure burnout, which includes emotional exhaustion, depersonalization and personal accomplishment The reliability and validity of the tool is well-established (Poghosyan et al. 2014). All these three elements are indicators of burnout. Emotional exhaustion measures the level of emotional exhaustion due to work, depersonalization measures impersonal response towards work responsibilities and personal accomplishment determines the feeling of competence in work. Burnout is defined by high score in all the subscales of the inventory. This tool is widely used in research studies to evaluate level of burnout in health care staffs and take adequate steps to address burnout issues (Bria et al. 2014).

CBI is the a new tool for measuring burnout which uses three scales which is the personal, work and client related burnout (Demerouti et al. 2010, p.209). Based on the score on each areas, the issue can be addressed by increasing motivation in staffs by providing flexible work timing, giving regular breaks and providing them staffs power to engage in decision making. This will motivate staffs to seriously engage in their care priorities and establish therapeutic relationship with patients.

Apart from risk assessment regarding the prevalence of burnout issues in nurse, several surveillance and monitoring procedure has been implemented in health care setting to reduce burnout and improve the quality of care. One of the strategies that have been adapted in high intensity setting is building resilience of nurse to reduce burnout among nurses. This is based on creating a healthy work environment and improving resilience of nurses. This goes in parallel with improving retention rates and reducing nursing turnover rate (McGowan and Murray 2016). Similar strategy was tested in a research study in which nurses working in high intensity units of hospitals were assessed regarding burnout, moral distress and resilience through 6 survey tools. This revealed that moral distress was a major predictor of burnout and nurses who have greater resilience achieves higher score in personal accomplishment. These nurses were confident about their competence level in the job. Spiritual weel being reduce emotional exhaustion whereas the physical well-being lead to personal accomplishments. Hence, development of strategies to reduce nurse’s vulnerability to emotional exhaustion will help in addressing issue of burnout and promoting patient safety and quality of care (Rushton et al. 2015).

Risk assessment, surveillance in improving care in relation to the indicator

Nurse can enhance the value of health care delivery by means of effective communication with patients and engaging patients in decision-making process. Effective communication is a key attribute to enhance patient’s satisfaction with care and provide them best care experience in hospital setting. Having adequate skill for patient-centered care is essential to fully partner with patients in decision making and yield positive health outcome. It helps to overcome cultural barrier to care delivery and manage conflict in nursing practice (Campinha-Bacote 2011).

In relation to the issue of burnout experienced by nurses, they can work to overcome this issue by means of self-evaluation and coping strategies. Reduced professional efficacy is seen due to inefficiency in work and lack of success in professional roles. This is the cause of burnout and creates the condition for occupational hazard among nurses. Core self-evaluation is emerging as a positive concept to modify personal and increase self-efficacy and self-esteem of nurses in practice. Self-evaluation practices promotes goal setting, commitment and engagement in the job responsibilities. This can be done bv evaluating job performance and identify the personal reasons for non-accomplishment in the job. A nurse who engages in self-evaluation practices is likely to more competent and confident about their skills than those who do not practice it (Li et al. 2014).

Apart from it, coping styles of nurse also determines their skill to manage job pressure and prevent feeling of depersonalization in practice. Different individuals may have different coping styles, which varies according to cultural, personal and psychological factors (Howlet et al. 2015). Nurses can improve their performance either by active coping or passive coping. Active coping strategy is to modify the nature of stressor instead of just thinking about it, whereas passive coping strategy is to engage in alcohl use or withdrawal from the pressure to address stressful events. However, passive coping is not the solution because it causes more risk to nurses both in terms of personal and professional context (Monter et al. 2014). Hence, use of active coping style is recommended for nurses to mitigate the negative impact of stressors and develop the skill to react to difficult situations. This will be an effective step to prevent burnout and improve nursing performance.

Nursing performance can be enhanced by building their resilience skill to manage stress in the job. This will help them to cope with job pressure and handle complex clinical situation and workload. Debriefing sessions can also be helpful for nurse to learn the ways to avoid burnout and judiciously handle complex clinical task. Apart from organizational role in providing flexibility in task, personal effort by nurse is also necessary to engage in critical reflection and idea areas of improvement. Based on this clinical judgment, future practice can be improved by means of utilizing best evidence in clinical practice.

Reference

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