August 2013 - Staying focused

Staying focused: Keeping patients at the center of health care decision-making

Over the past 18 months Saskatchewan’s health system has become synonymous with the concept of “transformation”.  With so much change happening so quickly all around us, it got me wondering: Are we staying focused on what’s most important?

There is no question we are in dire need of change. We have been falling behind in meeting the demands of our growing and ageing population, who have increasingly complex medical needs that require more and more of the system and those who work in it.

While there is no easy answer to what this transformation should look like and definitely no quick fix, one thing is certain, the clock is ticking and time is running out. We need to do something.

Arguably, the single greatest potential threat to patient safety and quality of care in Saskatchewan will be a loss of focus on the sole purpose for our health system’s existence – the patients and families who depend on us. They must remain at the center of each and every decision we make and their needs must be the primary driver for change. Unfortunately though, we have reached a crossroads and are now at risk of losing this focus due to the excessive budgetary demands placed on our Regional Health Authorities.

When Regional Health Authorities are forced to make organizational and operational decisions based exclusively on budgetary pressures, patients will eventually suffer. 

We would be remiss if we did not acknowledge the growing financial constraints we face today, but we cannot let the “bottom line” take precedence over patient needs.  It is fair to say this is easier said than done, as all too often these economic pressures are proving too great and decisions are being considered that are not necessarily always in the best of interest of patients.

When this happens we need to take a step back and look at what evidence exists to support our actions.

A significant and growing body of research points to the critical importance of having registered nurses at the forefront of any change.  This research is consistently telling us that appropriate registered nurse staffing is linked to better patient care.  This means shorter hospital stays, a decreased risk of hospital acquired infections and complications and ultimately better patient outcomes.  All of this translates into medical cost savings, improved productivity, and lives saved.  Research, therefore, clearly illustrates the significance of appropriate registered nurse staffing as a means to effectively bend the cost curve.

The registered nursing profession is rooted in clinical expertise and judgment, critical thinking, analysis, problem-solving, decision-making and leadership.  These skills have been acquired through extensive education and clinical experience. Registered nurses are the coordinators of patient care and no other provider has the required knowledge and expertise to do what they do. Quite simply, there is no substitute for a registered nurse.

When we see a decline in registered nurse positions in a system that is frequently at overcapacity we all need to be concerned.  When we see an increase in registered nurse layoffs and replacement with other care providers, in spite of what research and evidence is saying, we need to sit up and take notice.  With all that we know about the registered nursing profession and its impact on quality of care it seems counterproductive to be making decisions that reduce the numbers of registered nurses at the bedside.

There are many commendable transformational changes happening all around us under the umbrella of Lean Systems Management.  These range from primary health care redesign, to the Saskatchewan Surgical Initiative and new models of care such as Collaborative Emergency Centres to address rural emergency service deficiencies. Frankly, there is a lot going on and it’s all happening incredibly fast. 

If we hope to be successful and to truly improve access to high quality, safe patient care for all Saskatchewan residents we cannot lose sight of the patient. All future staffing, policy and other organizational change decisions must be informed by research, evidence and best practices and not simply dictated by dollars and cents.   

We need to stay focused, work together and repeatedly ask ourselves at every turn – “Is this in the best interest of the patients and families we care for?” The long and short of it all – the answer can be found in the research.

Tracy Zambory, RN



Visit to read the research and see how registered nurses make a difference.