The Commitment Between the Clinician, Patients, Manager, and The Organization

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As registered nurses we have a duty and responsibility to provide the best possible safe care to our patients and their families whilst juggling numerous tasks in a high tech environment. There are many variables that affect the delivery of healthcare and ultimately the commitment a clinician makes.  The demands placed on the nurse and performance expectations are constantly changing, often-times it can be overwhelming because the stakes are high.  Consider patient outcomes and patient satisfaction scores determine financial reimbursement and the organization’s performance ‘scorecard’.  The expectation is to provide safe, cost effective care without compromising quality in alignment with the mission, vision and values of the organization in a highly competitive market.  What exactly does this commitment mean for the clinician in the twenty-first century of healthcare delivery?

            Care must be efficient, better quality, with shorter wait times, and cost effective, clients (patients) must be educated and well-informed in order to encourage active participation in their care, and to facilitate informed decision-making.  Many organizations have chosen a model of care that is within regulatory compliance, state, and federal guidelines often-times with financial constraints.  Some organizations have adopted a patient-centered care model while others are using relationship-based care model to deliver care.  Nurses are required to learn the models in addition to learning new high tech equipment, biotechnology and evidence-based practices designed to provide safer care.  We (clinicians) think we know these models but in reality the knowledge and practices are variable and sometimes confusing across disciplines, departments and the organization which means the execution of care is inconsistent.

What is Patient Centered Care?

            Patient-centered care is a quality of personal, professional, and organizational relationships realized by clinicians and healthcare systems considering the patient (and their families) as central in the delivery of care (Epstein & Street Jr., 2011).  According to Epstein & Street Jr., helping patients to assume a more active role by engaging them as active participants changes the centuries-old physician dominated dialogues (2011).  The physician authors describe physicians must be trained to be more mindful, informative, and empathetic, in essence transforming their role from authority based model to one that incorporates partnership, solidarity, empathy, and collaboration.

            Patient-centered (individualized) care in past experiences (anecdotal) looks like this: Team work is stressed, nurse-patient relationship is advocated, shift to shift report occurs at the bedside involving the patient and family, evidence based practices are utilized, and open visiting is allowed in the critical care areas at the discretion of the unit staff.  The bedside nurse spends time explaining rounding decisions, treatment, and care to patients and families.  When families request to speak to the attending doctors, the nurse calls the team and relays the request.  Patient/family needs are accommodated. 

What is Relationship-based Care?

            Relationship-based care is described as the way a system provides care for patients, their families and caring for each other (clinicians) in a caring healing supportive environment with patients and families at the center.  The main concepts are concerned with caring for the providers of care (nurses, doctors and members of the interdisciplinary team of clinicians), not just the patients and families.  By helping clinicians take care of themselves they can best take care of patients.  This support is achieved by providing clinicians with the information on how to cope with the stresses of the job, skills to manage a multitude of tasks, and the numerous things required in order to provide the best quality, safe care.  Teamwork is key  nurses must establish a relationship very quickly with the patient (and family), listens to and tries to understand the individual needs, plans, implements and advocates, collaborating with the interdisciplinary care team to provide the appropriate time sensitive safe proactive care.  The goal is to provide the right care at the right time for the right reasons to the right patient.

The basic tenets, building blocks of relationship-based care include:

  1. Promoting and sustaining a healthy work environment through positive relationships within and amongst organizational leadership, managers, and clinicians, all people working together for a common goal – patients and their families.
  2. Accommodating needs of patients and families through relationships and human connections
  3. Maintain respect and dignity
  4. Advocating for the patient to include the family
  5. Understanding the uniqueness of each patient’s story
  6. Remaining consistent with organizational mission, vision, and values

Relationship-based care is a wonderful concept however, leadership and management teams need to make sure strategies employed are consistent with the conceptual guidelines for this type of care, all variables are considered and that it is implemented authentically and must be sustained in order for it to work.

Healthcare organizations have adopted models used by boutique hotels with greeters, valet parking, greenery, gadgetry, fancy towel motifs created by housekeeping to enhance the patient experience but all of this does not achieve the goals of patient-centered care (Epstein & Street Jr., 2011).  In order for clinicians to stay true to their commitment to patients and families, managers, and organizations the requisite support system must be established, be deliberate, deliverable, and sustainable to achieve the outcomes.  From my perspective, all talk and no action or all talk and inconsistent, confusing actions will result in inconsistent poor outcomes.  Essentially, the rhetoric practice gap must be bridged to avoid the performance practice gap and negative outcomes. 

Reference

Epstein & Street Jr. (2011). The Values and Value of Patient-Centered Care. Annals of Family

Medicine. 9 (2), 100-103. Retrieved http://www.annfammed.org/content/9/2/100.full

By Dr. Reezena H. Malaska, DNP, MSN, RN, CCRN

Critical Care Educator, Instructor, Author, Mentor, Coach                           Feb 18, 2019

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