Perioperative nurses have the power and the practice knowledge to redesign care delivery that is affordable and truly patient-centered again, asserts Marty Makary, MD, MPH, a surgical oncologist and gastrointestinal surgeon.
Dr. Makary is also a well-known New York Times bestselling author, health policy expert and influencer improving health care. In preparation for his latest book, The Price We Pay, Makary travelled the U.S. and spoke with patients, providers and administrators to understand the best and the worst of healthcare delivery.
He found patients who have lost trust in their healthcare system, exasperated by a lack of communication and coordinated care, and plagued by “money games” such as predatory billing practices and the refusal to offer price transparency.
“Isn’t the opioid crisis one manifestation of too much care?” he questions. “Healthcare is in a crisis of appropriateness and nurses need to believe they have the power to change this.”
Makary says no one is closer to the frontlines of patient care than American nurses. “I’m convinced as a surgeon that it’s nurses who have the ideas and the understanding of care delivery to put the focus on effective communication and coordinated care to put patients first.”
Here are three ways Makary sees nurses in leadership roles, working on the frontlines to drive this movement to return to its roots of patient-centric care:
- Speak openly and question what concerns you.
Too often fear of retribution prevents a nurse from speaking up, especially in an environment where the surgeon establishes hierarchical control. Whether it’s the risk of an adverse patient event in the OR or questioning an opioid prescription for postoperative pain management, nurses must voice their concerns as advocates for their patients, Makary notes.
- Share data with outliers.
Makary says nurse leaders must speak up themselves when the data they collect show surgeon activity beyond general practice guidelines, such as excessive and unnecessary surgeries. Makary currently leads such a data-sharing initiative called Improving Wisely to measure appropriateness in medicine using a physician-led, consensus process: “Civil conversation and honest data sharing from peers can go a long way to help outliers autocorrect.”
- Take time with patients.
Nursing care provides an approach to caring for the patient and their family members at a deeper level, and nurses on the front line need the time to be able to connect with patients on this level, Makary suggests. “Every person in the delivery of care is important, but it’s the nurses I work with who clue me in to the blind spots, whether it’s some important piece of information the patient didn’t share with me or just a deeper understanding of the patient.”