August FY24

[A Schutter]

Our August Journal Club comes from Kelsie St. Hill.  She chose an article from AANA regarding production pressures

Here is a link to the article. and the two questions to answer:

1.) What is production pressure ?
2.) Do you experience production pressure and how do you manage this pressure?

[sjsimmons]

As described in the article, production pressure is the emphasis on increasing efficiency, output, or continued productivity to increase monetary gain at the expense of patient safety. This leads to normalization of deviance, which occurs when unacceptable practices gradually become acceptable over time because no immediate adverse outcomes are experienced.

I believe we, as anesthesia care providers, experience production pressure on a daily basis – proceeding with elective surgery in patients without adequate optimization, pressure to employ anesthetic techniques that surgeons requested, pressure to reduce turnover time. Production pressure is detrimental to patient safety and can lead to errors in clinical judgement.

[Jessica Hadley]

Production pressure is defined as an emphasis on efficiency, output, or continued productivity to increase monetary gain at the expense of patient safety.

Yes, one example of this is a particular pain physician we work with. This Dr. routinely will have between 20-30 scheduled cases in a day both local and MAC. The expectation is that these patients walk in the room, position themselves prone, and are then deeply sedated (basically GA) in about 5 minutes. They then need to be awake again 5-10 minutes. Many of these patients are obese with multiple comorbidities. It is a challenge to manage this pressure! If I have a particularly challenging patient, I let the MD know the situation and how I plan to get the patient through the procedure safely.

[Jennifer Hannon]

Here is a link to the article. and the two questions to answer:

1.) What is production pressure? An unhealthy focus on increasing hospital efficiency at a lower cost, so there is more profit
2.) Do you experience production pressure and how do you manage this pressure? Yes! I cannot wait for the greedy tide to change and healthcare goes from buisness administrations to clinical administrations again. I'm afraid this will never happen again as well. The emails we get to be on time to the OR alone. Now, I ask all my patients if they have to use the bathroom before going back, even with a persuasive, "you sure??" More pressure now to wake up quickly, and the sighs are intolerable at times. Patient safety always wins for me and this is how I cope. It helps being tall and assertive for patient safety too.

[Wai-Ling Lo]

1.) What is production pressure?
Production pressure is to "do more, faster, with less." The quantity of productivity becomes more important than its quality.

2.) Do you experience production pressure and how do you manage this pressure?
Yes, I often experience production pressure. The management strategies for me include being vigilance and assertive; maintain open communication with all parties involved; avoid normalizing deviations; maintain work life balance and come to work well rested. The bottom line is patient safety can't be sacrificed.

[Benjamin Waldbaum]

1.) What is production pressure?

Per the article, they define it as: "Production pressure is the emphasis on increasing efficiency, output, or continued productivity to increase monetary gain at the expense of patient safety." I personally agree with this definition

2.) Do you experience production pressure and how do you manage this pressure?

I make an active effort to tune out production pressure when I perceive any impact on patient safety. I am not referring to inefficiencies that don't impact patient care. Patient safety is paramount

[aileenm4]

Production pressure is both a specific type and cause of Normalization of devience and contribute to poor patient outcomes

I believe we all find ourselves dealing with production pressures, earlier start times, surgeons rushing turn overs and them foregoing regional anesthesia beacsue they dont want to be delayed, non functioning or broken or TOS equipment. I always use a team approach and include my attending on the issues so that we can approach the surgeon, management, leadership together. I will not compromise if the equipment,bed, outlets, machine etc are not functioning.

[Belinda Gardner]

Production pressure as described above and in the article is: the emphasis on increasing efficiency, output, or continued productivity to increase monetary gain at the expense of patient safety. This leads to normalization of deviance, which occurs when unacceptable practices gradually become acceptable over time because no immediate adverse outcomes are experienced.

I believe we all experience production pressure routinely in all anesthetizing locations however it is our duty to safely care for our patients. I will make a point to communicate any safety concerns for patient care with the other members of the care team so we can make sure to provide the best and safest care possible to our patients. I will not sacrifice potential patient safety for turnover time or case start time if necessary equipment is not available, or I have not reviewed relevant patient history/ had adequate preop evaluation. Patient safety is always my priority above all else.

[Amy Swank]

1. Production pressure and/or Normalization of deviance occurs in many high stress industries as noted in he article, like aviation, to which our profession is frequently compared. I like the description of Production Pressure in the article as "overt or covert pressures and incentives on personnel to pace production not safety, as their primary priority". They often go hand in hand and one leads to the other.

2. I believe we all experience production pressure daily and it is the norm rather than the exception. I like what Jennifer Hannon said in her comments about the hope to get away from the business model in health care to the former clinical, health CARE approach that is the preferred model. Will we ever see this again? Or will we continue to care for our patients like widgets? Does anyone still remember the hospitals where the nuns trained the nurses and treated the patients' mind, body and spirit? They took a vow of poverty - definitely not like today. It is also noted in the article that inadequate organizational leadership regarding a culture of safety can lead to adverse outcomes" and "when production pressure increases, there is a corresponding rise in the occurrence of unsafe work practices by healthcare provider". Patient safety must be the priority.

I also am quite proud of the lead author of the article, Marjorie Geisz Everson, PhD, CRNA FNAP - our new program director at the Nurse Anesthesiology School. I had the pleasure to meet her recently at the school. She's an all around nice person and asset to the program.