Deadly Policies, Part I: The Gap Between Policy and Practice

By Ruth Elzer, RN, MS

One of the alarming trends in survey findings since 2004 is the apparent disconnect between policy and practice. At the bedside, well-thought-out policies are used by large numbers of clinicians who may not understand their subtleties, potentially resulting in unpredictable and sometimes deadly results.

Since The Joint Commission moved to the tracer methodology, forcing surveyors out of the board room and to the bedside, the gap between written policies and their implementation has widened. Often, the actions dictated by educators, managers, and compliance experts are not demonstrated during survey, resulting in Requirements for Improvement from The Joint Commission, and deficiencies from CMS.

The majority of hospital policies and procedures come under the authority of key stakeholders, such as educators, managers, and quality staff. They are then approved by leaders and medical staff, who depend on the stakeholders to assure that the policies are both compliant and practical for frontline care.

Too often, the first test of the practical elements of care comes when the policy is tested in real life settings with real life patients. Only then do clinicians discover that the policy lacks detail, refers to mechanisms or equipment not in place in the organization, or calls for a skill not known to the individual assigned. This is when policies can become deadly to patients.

This three-part blog series will look at the dangerous gap between policy and practice and give tips for writing and communicating policies to ensure understanding and compliance. Stay tuned for Part II of this series, “Writing Effective Policies.”