One More Time: Patient Care is Patient Safety

March 29, 2013

Returning from the American Organization of Nurse Executives (AONE) annual meeting in Denver last week was like coming out of the womb of caring that nurses bring to the urgency of caring for the ill. Thousands of nurse administrators from around the world came to this event to learn from each other and be inspired.

The conversation was all about patients — caring, and the challenge of living uncompromising values in the face of competing economic pressures.

Chesley B. “Sully” Sullenberger, the airline captain who brilliantly landed his aircraft in the middle of the Hudson River in January 2009 gave the opening keynote on patient safety and airline safety.

While patient safety issues were a major topic at AONE, I’m concerned that it still seems like an add-on. There is patient care and THEN there is patient safety. Sullenberger was emphatic that airline safety is not separate from service, comfort, or on-time arrivals. It is inherent to the existence of the airline industry.

Patient safety is also inherent to the existence of healthcare. Separating safety from patient care is the myth that keeps us at risk.

The larger question is how we put together a cohesive, seamless line that makes “caring for patients,” as broad as when Florence Nightingale first conceived it. We are in an era of silos, super-specialties, and operational models that honor these distinctions but do not create accountability between them.

IHI’s 100,000 Lives Campaign grew into protecting 5 million lives and changed the face and embodiment of the dictum “do no harm.”  Further, it broke through the silos to make each threat and risk everyone’s issue.

Systems theory would tell us that not looking at the complexities of a hospital within a cohesive whole is risky, inefficient, and causes problems.

Bottom line: Nursing may take on its own part in patient safety, but in practice, many other players, actions, policies, and issues are also in motion. Neither nursing nor medicine, administration nor facilities, can keep either patients or caregivers safe on their own. Once Sully’s plane landed, the members of the crew still had to get every passenger safely off the plane, a task that was not easy and had its own risks.

As a systems junkie, I’m confident that the safety and care issues will not only unify but will do so within a stronger organizational context.  The current shifting waters of healthcare require that we come together so we can “land on the Hudson” when engines fail or birds strike the plane.