Pathfinders are urgently needed! Flashback to 1914 and glimpse a slice of history that brings perspective to clinical leadership today. Let’s see what we can take away from a quick journey in time.
Consider the Landscape
One hundred years ago, it was early in the Great War, a time when everyone believed the war would be short-lived, and they would be returning to a world as they knew it. The brutal reality began to unfold daily, until more than five million people died.
By the war’s end, 13 million people had been wounded. Despite the incomprehensible agony and chaos of WWI, there were clinician pathfinders for patient care; they brought innovation, teamwork and the intangibles of caring.
Society was not the same at the end of the war. Rigid routines and boundaries were cracking and this could be seen early in the battlefield hospitals. Triage became more than an academic term as the numbers of wounded overwhelmed the usual routines. Doctors and nurses began to work across traditional lines. Nurses assumed many aspects of assessment and early management that had been the purview of physicians. Teamwork was evolving.
I doubt these clinicians saw themselves as pathfinders. They were simply adapting to the needs of their patients, just as many of you are today.
A century later, we are still evolving this idea of interdisciplinary teamwork. Our patients today deserve our rapid adaptation to an integrated approach in their care. So why are we still struggling with the concept of interdisciplinary teams?
Today’s Front Line
Demands in clinical care today are high, time is limited at the bedside and our patients have very complex needs. “Some days it feels like a battle,” as one clinician told me, “I don’t even have time to think.” These are red flags for administrators and clinicians.
Teamwork needs pathfinders in every organization. Sustainable solutions to errors and infections can only come when we accept an interdisciplinary approach to care and engage our patients in the process.
Do your electronic records support interdisciplinary entries? If not, there is a system barrier to interdisciplinary care. Do your patients receive a copy of their plan of care? If they do not, they are not able to engage in meaningful discussion.
Pathfinders, Are You Ready?
Busy clinicians need infrastructure to support interdisciplinary work, and that extends beyond technology to the operational methods of communication, hand offs and patient engagement.
Generals and C-Suites
If we are taking a patient-centric view of care in our hospitals, then I suggest the statistics with Healthcare Acquired Infections (HAIs) and errors are our wounded of today. One of history’s lessons from the Great War is the lack of coordination and adaptation by the Generals that led to ghastly battles, like the Somme. They could not see the complexity of the fighting and alter their views…so they often worked against one another.
C-Suites working from a paradigm that is centered on patient and families can bring an integrated view of care from the financials to the bedside. Expectations that nurses, doctors, pharmacists, therapists and support staff engage patients in an integrated and interdisciplinary manner are no longer talking points; they are the foundation to solving HAIs and errors.
Academia is adopting interdisciplinary courses in places like Virginia Commonwealth University Medical School . This is groundwork for the future but we cannot wait for the generational change this requires. Our patients need interdisciplinary teams caring for them now.
What Will History Say About Us?
Every clinician and administrator is acutely aware of the relentless pace and demands in hospital care. This makes taking risks even more difficult. Pressing for interdisciplinary teamwork in an organization where turfs are still guarded is big risk and tough work.
Tending to Today’s Wounded
According to the American Journal of Infection Control, “Overall, adherence to CLABSI prevention policies ranged from 37% to 71%, adherence to VAP prevention policies ranged from 45% to 55%, and adherence to CAUTI prevention policies was reported infrequently (range, 6%-27%).”
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