under development. In Seattle, medical groups are opening ambulatory surgery and diagnostic centers and adding capacity to deliver radiology, laboratory, and imaging services in their practices (Lesser and Ginsburg, 2003).

  • Private health insurance premiums increased an average of 15 percent in 2003—the largest increase in at least a decade (Center for Studying Health System Change, 2003). Consequently, employers are shifting more costs to employees. In some communities, malpractice premiums are continuing to rise (Lesser and Ginsburg, 2003).

  • Fully 80 percent of consumers say they want to receive personal medical information via the Internet. Currently, only 13 percent of physicians report communicating with patients by e-mail, although 39 percent said they would do so if security and privacy issues could be resolved (The Henry J. Kaiser Family Foundation, 2002).

Because of such developments, as well as the rapid growth of diagnostic and therapeutic technologies and biomechanical advances in knowledge,

BOX 8-1
Necessary Patient Safeguards in the Work Environment of Nurses

Governing Boards That Focus on Safety

  • Are knowledgeable about the link between management practices and patient safety.

  • Emphasize patient safety to the same extent as financial and productivity goals.

Leadership and Evidence-Based Management Structures and Processes

  • Provide ongoing vigilance in balancing efficiency and patient safety.

  • Demonstrate and promote trust in and by nursing staff.

  • Actively manage the process of change.

  • Engage nursing staff in nonhierarchical decision making and work design.

  • Establish the organization as a “learning organization.”

Effective Nursing Leadership

  • Participates in executive decision making.

  • Represents nursing staff to management.

  • Achieves effective communication between nurses and other clinical leadership.

  • Facilitates input from direct-care nursing staff into decision making.

  • Commands organizational resources for nursing knowledge acquisition and clinical decision making.

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