It is evident that healthcare is in need of a trajectory that leads the current system to a new enhanced system of change with less fragmentation and quality patient outcomes. Studies have reported that the United States spends more money per capita on healthcare than other countries with outcomes for patients that are comparable to those in the third world nations. This breakdown is caused by the many system failures within this complex intertwined network. These systems are so vast and intertwined that navigating them can seem overwhelming to healthcare employees and leaders. Where does a healthcare leader begin a trajectory of change within this maze of sub systems?

Micro, Macro, and Meso Systems

Healthcare institutions are defined as micro, macro or meso systems.  Micro systems are the front line of care, typically known as floors or units. Meso systems are the nationwide conglomerations that incorporate more than one facility such as the Veterans Health Administration or National Institute of Health.  Macro systems are typically a single facility but can offer many sub specialties in healthcare.  In theory, change should start at the micro level, just as a builder starts with laying a foundation when erecting a structure.  Laying a solid foundation should be first and foremost, as these are the front line link to quality patient care outcomes. If micro systems are able to deliver high quality care without fragmentation by kind, caring and empathetic staff, then strong macro systems can emerge. This would result in enhanced quality outcomes.

Joy in Work

So where does a nursing leader start to change the trajectory of healthcare to deliver exceptional patient care?  A starting point for nursing leaders must be improving staff morale and job satisfaction of the front line staff. Staff satisfaction has been linked to positive patient outcomes and improved patient safety and quality in many evidenced based studies.  Staff morale and job satisfaction affects the performance standards of the organization as a whole and it is imperative that data is evaluated to reflect this in its overall performance ratings. Recent studies have found that fifty percent of physicians report burnout and thirty three percent of new registered nurses leave their current job within one year (Perlo et al, 2017).  Turnaround can be extremely costly to organizations, with physician on boarding costing over a reported 1.2 million dollars and nurses as 1.2 to 1.3 times the cost of their salary (Perlo et al, 2017). This adds a burdensome and unnecessary cost to an already expensive system. So how does a nurse leader improve overall performance of their micro systems?

Listen, Learn, Lead

One evidenced-based model of care is a “Listen, Learn and Lead” model that incorporates a shared value that every patient and stakeholder has a voice in the process and an opportunity to be heard.  This model is data driven and patient focused using innovative and integrative ideas to improve and promote exceptional healthcare while empowering employees as stakeholders in the organization. This requires leaders to be engaged, passionate and actively present with the ability to recognize subordinates who also exemplify these qualities. Leaders can accomplish this by leading with example, engaging hearts and minds and consistent motivation of subordinates in the delivery of exceptional patient care.  Incorporating a shared value of compassion and empathy, along with engaged leaders and stakeholders can reduce burnout and result with a positive change for high quality and safe healthcare outcomes.

Member Written Article By:

Jodi Hess, MSN RN

Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. IHI Framework for Improving Joy in Work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017. (Available at ihi.org)