Consistency in Care Is Key: Buckley Lecture

Consistency in care would seem to be a given in treating the ill or elderly but, according to Mary Naylor, Ph.D., R.N., there’s a gap that occurs all too often and is noticed all too rarely.

Speaking to the College of Nursing and Public Health’s 10th annual Buckley Lecture at Adelphi University on February 25, 2015, Dr. Naylor—a professor of gerontology and director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania School of Nursing—laid out what has been the focus of her work for the last 25 years: the transitional care model (TCM) of healthcare.

Accidents happen when nursing shifts change or when patients switch doctors, Dr. Naylor said, citing a study that found a 70 percent error rate when information, on dosage levels, for instance, is passed from one care provider to another.

“We have day nurses that hand off, we have staff that hands off from hospital to home, and each one of those transitions represents a point of vulnerability,” she said. This causes stress to the patient and the impact is further felt by the “invisible workers,” as Dr. Naylor described the family members and other nonprofessionals who provide additional care.

Speaking on the topic “The Pivotal Role of Nurses in Providing Quality Care” in the Thomas Dixon Lovely Ballroom at the Ruth S. Harley University Center, Dr. Naylor was quick to point out that the fault lies not in education but in practice.

“This is not because we’re not doing exquisite teaching,” she said. “If you’re stressed and people tell you two or three things to do, you forget them or you don’t hear them.”

Rather than working in crisis mode, hospitals and other care facilities should be operating with “a high level of communication and a high level of asking questions,” she said.

By providing a holistic, family-centered approach with a single point person across all aspects of patient care, she said, hospital readmissions can be cut by as much as half, with expenses significantly reduced while the quality of care is improved.

“Consistency matters. I can’t stress that enough,” she said. “People value consistency. Collaboration matters if we’re going to get it right on behalf of patients. Relationships matter.”

While the model is still in the development stages and has yet to be put into common practice, provisions for its implementation were included in the Affordable Care Act. Dr. Naylor said she wants to see TCM integrated “further upstream” into nursing homes to help cut down on emergency room visits.

The talk marked the 10th anniversary of the Buckley Lecture after it was founded by the College’s dean, Patrick Coonan, Ed.D., R.N., NEA-BC, FACHE, shortly after he became dean of what was then the School of Nursing.