It was interesting in this study that there were not statistical improvements between the two units, specifically pointing to lower costs of care and and quality outcomes. Also telling was the last sentence under limitations: "Evaluation of the balance or patient care requirements .....was complex and time consuming." Truly indicative of the complexity of this Complex system.

I love this comment from the article: "If you put a critical pathway at the front of the experience, you're going to logjam everything,"
It so validates much of what we run into in complex systems. The old saying of getting the cart before the horse still applies.

This was a very interesting article using the short/long flow of biological systems. The most alarming fact to me was the concurrence that branching patterns of nurse's workflow is increasing (short and fast) yet the desire of nurses and patients is to spend more time at the bedside (long and slow) which may be at odds with the organizational structures of acute care settings and overall balance of the system.

After reading this article, I do agree this is the utopia in which we would all like to exist; however, until we can place these system interfaces together, then even the models the author cites can not be implemented. Being compliant with HIPAA, and developing the secure system interfaces that will allow the robust sharing of data among providers, pharmacies, patients, social workers etc appears to be huge barriers to successful implementation. Discovering the basic why and working on that fix may yield more in the future that developing the how.

For our informatics folks, this is a great "so what" article. Improving analytics and giving one a synopsis of care is truly meaningful, however from the clinical improvement perspective, perhaps what we are doing is forgetting the actual implementation for clinicians by clinicians integrating the multiprofessional viewpoints. Not being able to interface nursing and physician templates is by far the most frustrating. We are quickly becoming "task" oriented in the acute delivery setting.

The author does offer a common sense approach, and sadly to see this article was written 7 years ago reflects what little progress we have made in flattening hierarchies and including patients in transformational care.

This values based decision making approach has been used successfully in businesses such as the Ritz Carlton to empower employees based on the values of the organization. I often wonder why it takes us so long in health care to employ a broader base of autonomy for excellence.

Interesting article that also confirmed the root cause analysis of poor leadership and communication failures were consistently among the key factors leading to adverse events. To me personally these are key foundational elements to safety and trust.

As we are about collaboration and research, the above article takes it to a practical level. Are we truly integrating evidence based practice and continually sharing our knowledge in primary care?

Sibbald, Shannon L.; Wathen, C. Nadine; Kothari, Anita; Day, Adam M. B.
Journal of the Medical Library Association 2013 Apr 101 (2): 128-37 101 (2) 128-37