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Front-Line Staff Perspectives

Posted Mar 31 2009 11:19pm

As an economist, I conduct most of my analysis based on the quantitative data.  However, qualitative data should not be overlooked.  A paper by Tucker et al. (2008) looks at how the front-line hospital staff evaluates quality issues.  Some examples of their findings are:

  • The largest number of operational failures occurred in the equipment/supply category.  The reason for these operational failures were that supplies were often missing and equipment was also broken.
  • Poor facility layout often made it difficult for providers to observe patients.
  • Coordination among providers was also a problem. “hysicians reported inconsistent notification from nurses about changes in patient conditions, such as abnormal test results and drops in blood pressure. Nurses commented that physicians were often difficult to reach for consultation. In addition, OR staff reported that they were frequently uninformed about scheduling changes, which resulted in confusion and delay. Staff from all departments lamented a lack of advance notice about patient conditions—such as a need for supplemental oxygen or isolation—which created safety risks because they were unprepared when the patient arrived.”
  • Delays in getting lab tests results created significant bottlenecks in patient care.  
  • Poor hand washing practices increased infection rates.

Further, adopting a policy and implementing are two different things.  ”..while most hospitals had policies to satisfy publicized national goals, such as the use of two patient identifiers when providing care, front-line staff reported low compliance with such policies. This highlights that safety improvement is hindered by implementation rather than policy creation.”

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