Modern healthcare systems suffer from three major problems: The first problem presents with two facets, the under-representation of patient preferences in team conferences and the intra-team conflicts of doctors and nurses based on different perceptions of patient needs. The second problem - a consequence of the first problem - is healthcare overuse, which causes waste of resources associated with overtreatment and harm of patients. The third problem is the detection and effective prevention of harm to patients followed by poor hospital reputation and high liability insurance fees.
This lecture will demonstrate that healthcare teams need a new position to manage the three mentioned problems. Successful management of these problems will be measurable in ten dimensions. It will reduce harm to patients, intra-team conflicts, waste of resources, unnecessary expenditures, hospital liability fees and increase the representation of patient preferences, perception of safety, successful detection of patient harm, successful prevention of harm, and the hospital reputation.
To achieve these goals we need Y-Nurses who are experiences and strong, well-educated personalities, encouraged to ask “Why, doctor, are we doing this?”. These nurses will be taught in advanced methods of Ethics, Statistics, Evidence-based Medicine and Clinical Economics to identify even complicated errors and forms of bias. They will be trained to discuss the appropriate study design depending on a very precise (!) study question. Three different tools will shortly be presented to demonstrate EFFICACY (does it work under ideal study conditions?), EFFECTIVENESS (does it work under real world conditions?) and finally VALUE to patients and the society (is it worth it – of course under real world conditions). To demonstrate these three dimensions of outcomes Randomized Controlled Trials (RCTs), Pragmatic Controlled Trials (PCTs) and finally Complete Economic Analyses (CEAs) are needed. Not all doctors will be amused by this proposal of a new position within the medical team but almost no doctor is interested to do this strictly academic job. Most doctors are interested to look forward when they think of innovations. We hope nurses may be more interested to learn from the past especially from our own mistakes. This is the reason we expect that mainly nurse but not doctors will be interested in the challenging concept of the “Y-Nurse”.
Audience Take Away:
- Academic Nurses will be successful if they solve problems.
- Successful teams have to solve many different types of problems. Each of these solutions requires a specific qualification but not necessarily an academic.
- All members of the medical team have to be aware of the new strategy: respect and mindfulness to patients and team-colleagues.
- The primary objective is corporate identity: to solve the patient health problem with the least costs (i.e. everything that has to be given up) and the best consequences (i.e. what the patient will get back from the team). The primary objective of the medical team is EFFICIENCY.
- Financial aspects should never be our primary concern but we have to make sure we can solve the patient health problems when consuming private and public resources. Clinical efficiency will never cause financial problems. Efficiency is the best warrantee for success.