All health care organizations, regardless of their specific set of activities, invariably must deal with policies that create barriers to the effective, efficient, and safe delivery of care to patients. While debate continues over estimates of the amount of preventable medical harm that occurs in health care, Amalberti, Auroy, Berweick, and Barach (2005) state that there seems to be a consensus that health care in the United States is not as safe and reliable as it might be. This occurs for any number of reasons, including the need to limit the discretion permitted to various workers in the system, the need to reduce worker autonomy, the need to make the transition from a craftsmanship mindset to that of equivalent actors, the need for system level or senior leadership arbitration to optimize safety strategies, and the need for simplification (Amalberti, et al, 2005).
Most health care organizations must also overcome three unique problems. These organizations face a wide range of risk among medical specialties. They experience problems in defining medical error. Third, these organizations confront structural restraints such as the public's demand for services, a teaching function, and a chronic shortage of staff (Amalberti, et al, 2005).
Any number of strategies can change some if not all of the policies that are responsible for these barriers. For example, given the enhanced professionalization of many nurses who are certified nurse practitioners or advanced nurse practitioners with specialization, organizations ought to be less concerned with limiting the discretion and autonomy of these professionals who in many instances can fill roles that were once considered the exclusive purview of doctors. By enhancing the autonomy and expanding the discretionary powers of these nurses, patients are likely to receive a higher quality of care delivered in a timely and cost effective manner.
Additionally, most health ca...