I began my nursing career as a Licensed Practical Nurse with a primary purpose to be an informed consumer of healthcare services and provide safe quality care to the patients I serve.  Although my professional journey has made abrupt left hand turns when I thought I was going right, accelerated and decelerated through hills, valleys, and mountains, made a few U-turns and sometimes completely stalled, I would do it all over again.

Passion for Safe Quality Care

I can honestly say my primary purpose has not changed in the 20+ years that I have been practicing. I am still a healthcare consumer and often struggle with navigating the U.S. Healthcare system.  And I am a professional nurse committed to safe quality care. As a professional nurse, my passion has not diminished over the years, but grown from an individual silo perspective to a global perspective and moral imperative to share my knowledge and wisdom to improve safety and quality at local, national, and global levels. It is widely recognized that China has embarked on the largest health system reform the world has seen (WHO, 2016). Global health leaders have ignited initiatives and conversations to breakdown geographical boundaries and “improve health and healthcare worldwide” (IHI, 2016).

Thus, when approached with the opportunity to come to work in China to expand the professional footprint of nurses in China healthcare systems, I did not hesitate.

I packed my bags, obtained a visa and passport and headed to the other side of the world!  My journey has provided me the opportunity to expand my world view and be a change agent to improve global health.  I have always held the belief that to grow personally and professionally one must embrace opportunities when they are presented. This ideology has not failed me. My experiences in the China healthcare facilities has been nothing less than extraordinary.  Through thoughtful collaboration we work with the China healthcare system to introduce U.S. best practices proven to improve patient care outcomes.  Our relationship and recommendations has resulted in a dramatic shift in care delivery processes, roles and responsibilities.  It has been impressive to watch the China healthcare workforce embrace disruptive change and demonstrate a commitment to the fundamental goal that I began with many years ago “to provide safe quality care to the patients they serve.”

Facilitating Effective Change

My role has been to facilitate effective change.  However, the sphere of influence to change longstanding cultural norms comes from the institutional leaders as well as the primary workforce to effect change and embrace the vision of safety and quality improvement.  Our work has been transformational. Indeed, we have made effective sustainable changes with documented improved patient care outcomes.  Although some of the changes may be considered small from a U.S. perspective, they are significant in China considering some of the cultural norms in clinical practice have been in place for decades. For example, upon arrival my first objective was to complete a rapid assessment to identify a gap in knowledge, skill or attitude that I could be support with education and evidence-based strategies.  This assessment quickly identified a lack in effective communication strategies with patient-centered care as the focus of care delivery.  Through collaboration with the organizations, nursing leaders, physician colleagues, frontline staff and patient population we implemented bedside reporting using the Institute for Healthcare Improvements (IHI) Situation, Background, Assessment, Recommendation (SBAR) framework.  We developed the SBAR template, provided education to the team on the rational for effective communication, and role-played giving an SBAR report during AM rounds. Upon launch, the physicians provided the frontline nurses the opportunity to report the patient status and provide a recommendation congruent with their assessment. Within days, the entire hospital had adopted SBAR and bedside reporting. This resulted in significant improvements in patient care outcomes as communication became collaborative, patients became involved, just in time teaching occurred, and expectations clarified.

Lessons Learned

Healthy China 2030 parallels the US Healthy People 2020 initiative to improve the health and well-being of the population by ensuring healthier, sustainable environments where people live, work, study, and play.  In addition, the National Academies of Sciences, Engineering and Medicine (2017) report: Global Health and the Future role of the United States advocates for a commitment to global health “to secure protection against global health threats, and to promote productivity and economic growth in other countries” (pg. S-1).

Considering Health China 2030 and the future role of the U.S. in global health, our work has just begun. We have ignited a “spirit of inquiry” and empowered our China colleagues to challenge traditional norms and become advocates for safe quality patient care. I am looking forward to continuing this journey.  Undoubtedly, there will be left hand turns when we thought we are going right, acceleration and deceleration through hills, valleys, and mountains, a few U-turns and perhaps we might completely stall and will need to restart the engine.  However, if I could predict the future, I am sure I will be saying “I would do it all over again.”

References

Institute for Healthcare Improvement. (2016).  Vision, Mission, and Values. Retrieved from:

http://www.ihi.org/about/pages/ihivisionandvalues.aspx

National Academies of Sciences, Engineering, and Medicine. 2017. Global

health and the future role of the United States. Washington, DC: The National Academies Press. does: https://doi.org/10.17226/24737.

World Health Organization. (2016). Healthy China:  Healthy China 2030 (from vision to action). Retrieved from:  http://www.who.int/healthpromotion/conferences/9gchp/healthy-china/en/

Dawna L. Cato PhD., RN
Vice President Clinical Care Services
PreferUS Healthcare