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Physicians who are dismissive to nurses affect quality of care and bottom line


Are physicians unknowingly compromising the quality of care by discouraging nurse input in the process? Barbara Lewis, founder of Joan’s Bill of Rights, asked nurses that question and their answers might surprise you. She talks about what she discovered, makes a case for why nurse involvement in the process is critical, and proposes a solution that would help determine if doctors and nurses are truly collaborating which leads to better outcomes and HCAHPS scores.

Lewis: I want my care team, either with me or my family member, to include everybody, to include the nurses participating, and giving their opinions.

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Interviewer: I think we all assume that physicians and nurses are collaborating and talking to each other, but that might not always be the case, surprisingly enough, to I think patients and also people that run hospitals. We're with Barbara Lewis. She's the Founder of Joan's Family Bill of Rights, an organization that is helping to improve the patient experience. And from personal experience, you learned that doctors and nurses don't always collaborate, to detrimental outcomes at times. Tell me that story.

Lewis: That's right, Scott. My sister was in the ICU for two weeks, and I had a lot of interaction with everybody who came into the room, and what I noticed was that the nurses were coming up to me and they were saying, "I don't know why the doctor did this. I don't know why the doctor gave these meds. I don't know why the doctor took this much fluid." And finally, the third time that I heard this I said to the nurse, "Why don't you ask the doctor why?" And the nurse said to me, "Well, in this hospital the doctors don't listen to me, to us," meaning all the nurses. And I thought, "Oh, my gosh, that is such a strange thing."

I begin asking the nurses about this, and I found that this was the case, that the doctors basically were not listening to the nurses. I saw it firsthand in the rounding that was done when the hospitalists got together, and basically the hospital is dictated. They said do this, do that, they may have asked have you done this, to the nurse, or have you done that. But they never solicited the opinion of the nurse.

And I know from research, since that time when I have been researching this subject, which I'm calling Collaboration between Doctors and Nurses, that we have evidence-based research which shows that when the collaboration between the doctors and the nurses is high, the outcomes are better, and in fact, that when that collaboration is high, it becomes one of the biggest drivers for high HCAP score, which is the hospital patient survey scores. So I have been just intrigued by this idea of collaboration level.

Interviewer: It's kind of crazy to me that doctors might dismiss the nurses' expertise. Do the physicians realize they're doing it, or do the hospital administrators realize it's happening in their hospital?

Lewis: No, I don't think that the hospital administrators realize it, and in fact when I brought this observation up to the Chief Nursing Officer, she had no idea that was going on. Whether or not the doctors know it, they might, but I think this is just their attitude. They tended to be very arrogant and they didn't listen to the nurses. They didn't ask for their opinion.

I want my care team, either with me or my family member, to include everybody, to include the nurses participating and giving their opinions and the doctor giving their opinions as well. Now I look at the fact that we have 100,000 human diseases and we have 10,000 prescriptions, and how is a doctor supposed to know everything? It's too difficult to do this. And yet when I brought up to the doctor that my sister was on heparin, which you're not supposed to be on when you have a liver condition, the hospitalist, he said to me, "Do you want your sister to die of a blood clot?" And I said no, and he says, "Well, we're going to give her this then," and just dismissed me.

Here I am, somebody who teaches research at UCLA Anderson, where I graduated with an MBA, and I was an investigative reporter, and I was spending 18 hours on the internet, and I was contacting experts all over the country about my sister's condition, and I was just completely dismissed. To his credit, he did give her a test the following day and found that she tested positive for heparin induced throm-something or other, and they immediately took her off heparin.

But I just think that doctors and nurses need to communicate and they need to collaborate with family members, too. Here I was coming to him with a valid concern that had he been somebody else he might have said, "Let me take a look at that. Where did you get the research? Let me talk to this person. You know, let me look into this myself." But I didn't have that response at all, which is extremely disappointing.

Interviewer: Yeah, you got a little taste of what some of the nurses must be experiencing in similar situations.

Lewis: Yes, exactly. So I'd like to change that. I'd like to have a collaboration scale for every hospital. That's one of my goals.

Interviewer: So that's how we fix it. What are your thoughts on fixing it, the collaboration scale?

Lewis: Yes. I think that's the thing to bring it to the attention of everybody. I think that if I could get certain nurses in every hospital to participate in a survey, and that the hospital saw the results, that the nurses didn't think that the doctors were collaborative, I think that they would do something to change that. Because the evidence is out there that we need that collaboration, both to drive HCAP scores, which is now related to money, and also the fact that the outcomes are better and that's evidence-based.

Interviwer: And you're actually looking for a partner to make this a reality.

Lewis: Well, I'm searching right now for a grant to do this research. I know it would take a lot of time to do national research. I'm thinking of a pilot research with the health system initially. I need someone brave who would step out there and say to their health system, "Yes, we want to find out what the collaboration level is." And I'd just like to remind everybody that it's the better outcomes with collaboration and more money with collaboration since it's the one factor, the one driver that they're saying in HCAP scores. So if anybody has any means to help me here, I would love to hear from you.

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By: Scot Singpiel

Scot Singpiel is senior producer for