Small Changes, Large Impact

Sometimes, when we think of making a difference in health care, we think of major changes – introducing new technology or surgical skills. What we often forget are the small elements of day-to-day work that we take for granted but that can have an enormous impact. I recall two incidences of those kinds of changes that really affected care.

The first occurred back in the early 1990’s, when Marie O’Toole, RN, EdD, CRRN, was working with the nursing staff in Vietnam as part of our USAID-funded rehabilitation project. The nurses had been frustrated with the bedsores the patients seemed to constantly have. Dr. O’Toole returned on one of her frequent visits to be greeted by the nurses in tears of joy. They were so pleased that the simple act of turning the patients in bed, as Dr. O’Toole had shared with them, had eliminated the bedsores.

Another small act of impact occurred nearly twenty years later. Shaun Berger, MD, was working in a hospital in Nicaragua and noticed that many of the other physicians were not washing their hands between patients, due to a frequent lack of soap. He saw that an infectious disease physician was routinely using an alcohol gel in his patient encounters. Dr. Berger realized that reinforcing this practice would serve as a model for the other physicians in the hospital. He purchased a small, inexpensive bottle of alcohol gel which he carried in his lab coat at all times and began using with each patient visit, modeling a simple solution to an important problem.

Both are simple behaviors, but both made a significant impact in patient care!

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