Fixing Hospital Care is a Matter of Life or Death

by Bonnie Eissner

Wei Liu, Ph.D.,

Running a hospital well or badly has life-or-death consequences. Wei Liu, Ph.D., and Susan Zori, D.N.P., know this all too well from their long experiences as hospital nurses and their more recent pursuits as academic researchers.

Prior to joining the Adelphi faculty as an assistant professor in the College of Nursing and Public Health, Dr. Liu worked for more than a decade as an emergency room nurse in China and Australia. Dr. Liu became fascinated by the complexities of how nurses, doctors and pharmacists communicate across their various disciplines in order to dispense medications.

What does it mean, for example, that doctors make medication decisions at the central staff station, away from patients’ bedsides? Or that they make their medical ward rounds when nurses are absent? What is the impact on patient care when doctors, nurses and pharmacists conduct separate staff meetings?

Susan Zori, D.N.P.

Through interviews with and observations of doctors, pharmacists, nurses and patients, Dr. Liu documented patterns of communication and miscommunication in medication management at a major metropolitan hospital in Melbourne, Australia.

As a nurse in a separate ward at the hospital, Dr. Liu was able to establish credibility and rapport with the professionals and patients she was studying, to the point that they allowed her to videotape their clinical interactions.

Dr. Liu’s ultimate goal was to improve patient safety at the hospital. In addition to publishing papers based on her research, she took her findings back to the hospital professionals. In focus groups, she shared her data and a DVD she produced and encouraged discussion. Her aim, she said, was to “have them look at their own practices to see where the communication gaps might be and how we could improve our interdisciplinary communication and then improve our patient safety.”

Dr. Zori, a clinical assistant professor at Adelphi’s College of Nursing and Public Health, has practiced nursing for 40 years, many of them as a nursing director at prominent hospitals in New York City and on Long Island. During decades of overseeing teams of nurses, she grew curious about why some teams exuded positive energy and excelled while others seemed disgruntled and performed less well. She suspected that the nurse managers’ critical thinking abilities and attitudes played a significant role.

In an often-cited study of nurse managers and their staffs, Dr. Zori and her colleagues validated this hunch. Nurse managers who scored high in seven categories of critical thinking disposition, ranging from open-mindedness and inquisitiveness to truth seeking and cognitive maturity, had staffs who felt better about their work and, as a result, were more likely to provide safer and more effective patient care.

Dr. Zori has since been testing ways to boost the critical thinking skills of up-and-coming nurses. Working with administrators at North Shore-LIJ Health System’s Center for Learning and Innovation, for example, she created a critical thinking class for nurses in the system’s fellowship program. From journals that the nurses kept, Dr. Zori observed that many had become more attuned to the importance of being inquisitive and analytical in their work.

In her classes at Adelphi, Dr. Zori encourages critical thinking by emphasizing case studies and interaction. “For me, it’s constantly challenging myself to find a way to get [students] to critically think and to be creative and interactive so that they’re not just learning information, they’re applying it to real-life situations,” she said.