affairs of job satisfaction. She exuberantly shared how pleased she was that she was so easily able to read her unit story and identify what aspects of the story were most important. She said they’d been calling the report their “bible of operations” because it provided a clear map for action planning. This “bible” was worn with use which informed me without words that they were entranced by their data and its application to operations. They could prioritize what needed to be addressed first, second, and so on, knowing that time and dollars would not be wasted on ill‐conceived efforts. We measured data every 15 months, and by the time we measured again, they were eager to respond and see results generated by their unit‐specific model that told their unique story. Her unit scores were among the highest in the 800‐bed urban hospital, and the response rate for her job satisfaction survey increased every year until it was consistently at 100%. Staff knew that if they responded to the survey, their voices would be heard and acted upon. They all loved to not only hear their own story, derived from the data they provided, but to collaboratively work to make the next story even better.
When is the last time you read a report that was so meaningful, relevant, and helpful that it changed forever how you do your process improvement work? The biggest reason we do this work is because we have seen the power it has to improve the lives of patients, families, and everyone charged with improving quality, safety, the patient experience, and the financial performance of the organization.
When is the last time you read a report that was so meaningful, relevant, and helpful that it changed forever how you do your process improvement work?
Implications for the Future
Readers of this chapter are likely to relate to at least one of the 16 steps identified: administrators understand the outcomes; nurses understand the hunches; theorists understand the use of formal and informal theory; analysts understand the math; engineers, data scientists, programmers, and informaticists understand the movement from manual to automated data collection and reporting; and some of these people understand many or all of these 16 steps. Much of the guesswork is eliminated as hunches are tested mathematically before they are tested in practice. When healthcare organizations start using predictive analytics to improve outcomes, a big change happens in the care environment as better informed choices are made in how care is provided. Using the 16 steps described in this chapter will enable people in healthcare to move beyond managing negative clinical, financial, or operational outcomes, into a new paradigm of providing care. This move from reactive to proactive management of outcomes puts organizations light‐years ahead of where they would otherwise be, while engaging teams in ways few of us have ever seen before.
When healthcare organizations start using predictive analytics to improve outcomes, a big change happens in the care environment as better informed choices are made in how care is provided.
2 Advancing a New Paradigm of Caring Theory
John W. Nelson and Jayne Felgen
A paradigm is a model or example of a way to view things. New paradigms seek to deliver new truths. This fifteenth century concept was applied to social sciences by Kuhn in an essay which proposed that new models and ways of thinking in science are always rebuffed by traditional views until a convincing argument is provided through careful assemblance of the new theory into a model (1962). Models for social and psychological constructs are built on observations and beliefs. Sometimes these observations and beliefs are discussed among scientists who then may conduct research, using models, to study the veracity and validity of these observations and beliefs.
The notion that “caring contributes to healing” is a paradigm held closely by people in various disciplines in healthcare, and it is the very core of the profession of nursing (Lazenby, 2017). This chapter discusses the paradigm that caring contributes to healing, and it describes a number of frameworks of care delivery that seek to operationalize and systematize caring behaviors and to promote, support, and nurture caring in all relationships in healthcare. Nursing has done an excellent job of generating caring theories and frameworks of care delivery, but a poor job of creating an argument rooted deeply enough in verifiable data and scientific rigor to convince the broader scientific community that caring contributes to healing. This book makes a scientific argument that caring does indeed contribute to healing. This chapter reviews the theories and frameworks that have been tested throughout this book. Watson's Theory of Transpersonal Caring (2008a) is the predominant theory of caring science, and Relationship‐Based Care® (Creative Health Care Management, 2017; Koloroutis, 2004) is the predominant framework of care. However, there are other caring theories and frameworks of care that are reviewed in this book as well.
A special note is made here about the framework of care called the Caring Behaviors Assurance System© (CBAS), because it is the framework of care for which there currently exists the most specified measurement instruments to capture the overall effectiveness of its implementation and outcomes and thus the argument that caring contributes to healing. Chapters 17 and 18 provide a thorough description of CBAS as well as a review of how its effectiveness has been successfully measured. It will not be reviewed in detail in this chapter on theory and frameworks because it is so thoroughly reviewed later and because earlier case studies in this book are taken from organizations using other frameworks of care.
Maturation of a Discipline
Nurses have revolutionized healthcare at least twice. Florence Nightingale's reformation of care delivery is the most well‐known example. Prior to Nightingale, care delivery was provided by monks and nuns of religious traditions (Goodnow, 1929). Nightingale's method of care delivery in 1854 espoused the need for a clean environment and individualized care of the patient (Nightingale, 1959). By insisting on a clean environment, she ensured that germs were not spread as rampantly from patient to patient. In effect, her adoption and enforcement of the paradigm “environments of care must be clean” improved patient safety. Germs and how disease spread were not clearly understood in the mid‐1800s, but scientific advancement is often discovered by accident (Kuhns, 1962). Nightingale's ability to document a decrease in mortality rate from 42.7% to 2.2% for soldiers in the Crimean war gained worldwide attention which resulted in her woman‐only model of nursing becoming the standard of care across the globe (McDonald, 2001; Neuhauser, 2003).
A second occurrence in which a nurse revolutionized healthcare is less well known. It was led by Agatha McGaw, a surgical nurse. It was McGaw who in the 1890s observed that patients often underwent surgery with great trauma and risk due to the methods used for anesthesia. It was her belief that this trauma and the associated deaths were due to the administration of too much anesthesia and/or the rapidity with which anesthesia was being administered. In response, she developed a method of administering anesthesia to patients by dropping the anesthesia medication into a cloth that was placed over the patient's nose and mouth. The anesthesia was taken in by the patient as the patient inhaled. The rate of dropping fresh anesthesia onto the cloth covering the patient's nose and mouth was adjusted based on the patient's rate of breathing, with fewer drops applied when the patient's breathing slowed, and more drops applied when the breathing rate increased. Using this method of administering anesthesia, she recorded giving anesthesia to 14,000 patients, none of whom died. Her observation of the patient, and adjusting treatment to the patient's response, resulted in the establishment of the profession of anesthesiology and a new paradigm of how anesthesia was administered, based on the patient's observed physical response (Koch, 1999; Pougiales, 1970).
Could the effectiveness of caring, as a proven way to hasten healing, be the third medical revolution put forth by nursing? Watson (a nurse) asserts that when nurses enact caring behaviors toward themselves and/or others, healing is facilitated (2008a). This is yet
