“Rules are for when brains run out.”
Is that a great quote or what? It came out of the mouth of the honourable Mr. Fred Horne, Minister of Health, in his concluding remarks at the Inspiring Quality in Continuing Care Conference October 8-9 in Edmonton.
Mr. Horne is a very smart man, with a strong understanding of our complex health system—and in those few words he really captured one thing that has been troubling me across a number of sectors in health care delivery, including continuing care. I call it the “toolkit phenomenon”. It seems that everywhere one turns these days, there is a new “toolkit” for front line providers—and they cover from how to greet people, to how to ‘do’ primary care—all I can say is that the corresponding tool-belts must be getting awfully heavy!
Now let me be clear, I do understand:
- the tremendous value of checklists for enhancing safety
- the helpfulness of reminders to do things
- the value of guidelines to enhance the consistency and quality of complex care
- the utility of algorithms for unambiguous, step-wise processes
What makes me uncomfortable is that toolkits, checklists, algorithms and guidelines are not a replacement for the knowledge and judgment of expert care providers in an increasingly complex health-care system.
One of the plenary speakers at the conference, Dr. Lori Shindel-Martin, had a refreshing approach to the use of ‘tools’ in her discussion of how to prevent inappropriate transfers to acute care from long term care. She was very clear: tools are just tools, but they can be useful in helping us communicate more clearly with one another, within a context where someone had the knowledge, skill and judgment to act on that communication with this complex population. Dr. Martin described how expert nursing assessment and intervention at that critical early point of deterioration in a long term care resident was the key factor in preventing an inappropriate, distressing, health-compromising (and expensive) transfer to acute care.
Toolkits and ‘rules’, even good ones, aren’t going to help you much without the knowledge of expert caring behind them.