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Missy Mendez, a nurse manager of a 95-bed medical-surgical unit in Yucatan, Kansas, would like to have her health care organization, Yucatan Memorial Health Center, embrace the concept of a high-performance organization. She would like administration to develop a culture of a high-performing organization. Nurse Mendez knows that high-performance organizations have leaders who communicate a strong and clear mission and vision to employees, engage in strategic thinking that anticipates customer needs and market changes, commit to ongoing identification of problems, have a preoccupation with potential failures, are resilient and flexible, and use creative and improvisational problem solving to address failures or near-misses. Nurse Mendez approaches the director of nursing and provides multiple resources and contacts about the high-performance organization concept. The director asks her several questions about how she could coordinate hospital-wide efforts to describe this concept and support a customer-focused, team-based organization to support quality efforts. Yucatan Memorial Health Center, although it has a good quality improvement process, historically has emphasized individual successes and unit-based projects and tends to be punitive when managing clinical incidents.
Nurse Mendez proposes a change from the punitive culture to a system in which staff is rewarded for reporting errors. The director of nursing is concerned, however, that “this will obviously make it look as if we commit more errors than other nursing units in other health centers who do not use this system.” How can Nurse Mendez alleviate the director’s fears on this particular issue?
2. Part of the quality improvement process, of course, involves nurse managers implementing what Nurse Mendez refers to as a health care quality toolbox. For example, one unit frequently grapples with the problems encountered in scheduling radiology for patients. Some patients are scheduled specifically for diagnostic procedures, while others at the center are sent to radiology spontaneously by their physicians during a medical appointment. To eliminate as many scheduling problems as possible, she asks affected nursing managers to diagram causes of each scheduling conflict as it arises, including unclear policies or protocols, poor placement or number of equipment and machines, and time each patient spends in radiology awaiting either tests or results. This particular strategy is an example of what sort of tool?

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