We need a paradigm shift in regulatory management

[dhowell]

Having just undergone our facility's annual Dept of Health survey (long term care) I would like to venture a few comments about the process which I find to be counter productive to the original intent of regulatory oversight. Let me preface this by explaining that I have not always worked in health care as a nurse, I have worked in other industries, including working for an electronics firm that developed radar systems for the navy where I had a top secret clearence. I am looking at the processes as one that has been exposed to other "cultures" of governmental regulation, not as someone who has only been in healthcare...specifically nursing...their entire working career. I find the entire process as being accusative, arbitrary and punative where the facility is presumed to be guilty and has to "prove" that it has indeed followed all the regulations to the very letter of the law. This is counterproductive to the goal of providing quality health care. We need to take a systems based approach to evaluating if there are deficiencies in the system that prevent the delivery of quality care and make changes to the system without all the accusatory finger pointing and blaming that goes on...especially the attitude that the deficiency requires punishment. Health care needs to take a lesson from other industries where a systems failure is not taken as an instance to assign blame and punishment...this is counterproductive and only causes the event to be addressed, not the system that caused the failure to occur in the first place. Assigning blame only causes the "blamed" to go underground (so to speak) to escape further blame and punishment, so the root cause is never addressed and the cycle of deficiencies continues unabated. Take the aeronautical industry for example. System problems, "mistakes" if you will, are not treated as punative events but are looked upon as opportunities to evaluate why the system failed, which serves to encourage the people in the system to report these things rather then try to hide them because of fear of punishment. I really am not opposed to having regulatory oversight, in fact I appreciate having another set of eyes looking into my programs to pick up on something that I might have missed, because my goal is quality care for the people entrusted to my care. I need to see if my system is lacking or failing in some way, but doing that the way things are now is very difficult.
So lets start discussing how the current regulatory culture for our industry affects us..in what ever arena we work in...and let's discuss our perceptions of our systems, how we need to address our system failures and how we need regulatory oversight to do the same, so that working together as a team, we can all attain our common goal of quality care. So who's next? :)