Last week, while walking through an airport, I stopped to watch planes coming into the gates, and observed the process that occurred each time. Doing so reminded me of how people outside of the healthcare industry often advise us to use techniques from other industries as a way to improve patient safety. One industry that is always cited for dedication to safety and quality is the airline industry. As I watched, I became aware of why the systems that are implemented in the airline industry may not be as easy to implement in healthcare as some think. This is because the process of servicing the plane is fairly routine.
As I watched, I saw the gate agent move the jetway to the plane to allow passenger to disembark. Next, the team responsible for servicing the plane went onboard while the baggage handlers began to unload the luggage compartments. At the same time, the maintenance crew went about doing their maintenance checks to ensure all of the various parts were in working order before the next takeoff. I am sure there is more to it, but from the outside looking in, the process looked very organized and routine. I came to realize that this was because each person was working on the same machine and each machine was almost the same, so any abnormalities could be found and fixed in the short turnaround time, or the aircraft simply taken out of service if more extensive work was needed.
In healthcare, we work with people, and as most of us know who have been in this business for some time, no one person is alike. The body is a ‘type’ of machine, and yes, we all have similar systems (brains, spinal cords, hearts, lungs, livers, kidneys, GI systems, etc.), but how each individual person’s body reacts when one or more of these systems gets ‘off track’ differs from person to person. Also, as people we have feelings, goals, and a purpose in life. When we are faced with health problems that jeopardize our lives, we react differently. In addition, most of feel that we have “control” over lives. Yet, when stricken with an acute injury or a chronic disease, that control can seem as if it’s been suddenly taken away. As a result, we’re forced to rely on the healthcare system for answers that address our problems and to assist us in regaining control so we can go on with our lives. As case managers, we must have the empathy to understand that this would not be easy for anyone. I am sure there are many things we can learn from other industries regarding quality improvement techniques that will help us improve the healthcare system, but for real change, we still need to look within for the real answers.
Case managers are at the forefront of the quality and safety movement as we are the one professional in the system that has an overview of the entire healthcare continuum, and see firsthand how it impacts the patient and his or her family who are dealing with a catastrophic illness or chronic disease. We see how patient perceptions of losing control can impact compliance and lead to complications and setbacks. We know from our clinical expertise and our work with other members of the healthcare team what steps need to be taken to assist the patient toward wellness. And we see the value of the entire healthcare continuum working together as a team to ensure all of these steps are followed. Our role is to assess, plan, advocate and evaluate. As a result, much of our work focuses on educating the patient, gaining their trust and buy-in to the process, helping them keep the plan of care on track, and adjusting that plan as needed as issues and complications arise. We are a resource to the healthcare team and the patient, as we are familiar with the benefits and we are the one healthcare professional able to identify and tap into community resources available to help meet the patient’s individual needs. We do this one patient at a time, and one day at a time, because we know that no two patients are the same and each patient has different sets of circumstances that need to be addressed.
Quality and safety take resources and time to implement and evaluate. Make sure your case management department is part of the team involved in addressing quality and safety at your organization. You have valuable insight into the process to offer and are an integral part of the solution.
Till next week, thank you for the work you do as you work with one patient at a time!
Anne Llewellyn, RN-BC, MS, BHSA, CCM, CRRN
Editor-in-Chief of Across My Desk, Case in Point magazine, and the Case Management Resource Guide
allewellyn@dorlandhealth.com
