Running head: HEALTHCARE INDUSTRY RESEARCH

Healthcare Industry Research

Ivan Jesus Gonzalez
Nevada State College

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Introduction
In the healthcare industry, patient safety is as big of an issue as worker safety, although
miscommunication is much too common. Since the release of the landmark institute of medicine
study in 1999, reducing the amount of medical errors has been top priority (Kohn & Korrigan,
2000, p.2). The Committee on Quality of Health Care in America founded a study in 2000 stating
that preventable medical errors account for as many as 98,000 patient deaths per year
medication errors alone caused up to 7000 of those fatalities (Kohn & Korrigan, 2000, p. 27).
One could agree that the numbers alone are shocking, but this continues to be an ongoing
problem. This large number of fatalities raises the question: How do healthcare professionals
writing skills impact patient care?
Literature Review
The literature review contains two different themes on the impact that healthcare writing
can have on patient care. One of these themes is the communication and miscommunication
among doctors, nurses and medical assistants. Miscommunication among health care
professionals can provoke adverse advents such as medication errors or even technical
malfunctions. The other theme is the differential between the training that a physician must
undergo compared to a nurse practitioner and its effect on both of their writing skills.
The communication on diagnoses of patients among doctors, nurses, and medical
assistants should be clear and concise. All of these healthcare professionals have a vital role to
play when performing their duties. Writing skills should be just as important as communication
among peers. The documentation within medical records is very important because it contain
the patients history, clinical findings, diagnostic test results, preoperative care, operation notes,
post-operative care, and daily notes of a patients progress and medications (Thomas, 2009,
p.4). These are just a few examples of why communication is key when having to carry out these
procedures patient by patient. However, miscommunication can occur due to physicians

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assuming that entry into the computer system replaces their previous means of initiating and
communicating their plans, and that orders will be carried out without further action on their
part (Gorman, 2003). As a result of this miscommunication, orders are missed, medication is not
given, and diagnostic tests are delayed. A medical professional should make sure that he or she
communicates clearly with whoever takes over handling the patient. In this case, it could be
between a nurse and a physician in the transfer phase. If this is not preformed successfully, then
errors are bound to occur.
Medication errors are not only dangerous but are also very costly. Medication errors in
Australia resulted in 80,000 hospital admissions in a year costing the country 350 million dollars
(Ash et. al, 2004). Although adverse events are not completely caused by miscommunication, at
times physicians do not focus on errors that were caused by technical dysfunctions or even faulty
programming. Unfortunately, these hardware problems are much more common than they should
be, and this is critical especially in a field like medicine. However, these problems can be
avoided through testing before implementation, and often errors that occur due to individual
dysfunction are not discussed (Gorman, 2003). An example of this could be a physician refusing
to check for a technical problem because it is simply not his task.
Although the healthcare industry contains a complex variety of medical professionals,
there could be a differential between a nurse practitioners skills in writing compared to a
physicians. Both of them have a similar goal in mind and that is to improve patient outcomes,
but barriers that do not allow for successful collaboration exist. Physician dominant
organizations as well as the American Medical Organization believe that physicians' longer,
more intensive training means that nurse practitioners cannot deliver primary care services that
are as high-quality or safe as those of physicians (Fairman et. al, 2011). Many times, the records
that physicians must use are written by nurses or medical assistants, but this can be difficult due

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to the fact that some physicians believe that nurse practitioners are lacking competence to
provide quality healthcare to begin with (Fairman et. al, 2011).
The ability to compare physicians with medical degrees and nurse practitioners was not
possible in the past but now nurses can obtain higher level degrees. The roles between the two
used to be easily distinguished due to one wearing a white coat and the other one wearing a white
uniform cap, and this is not the case anymore. Even patients cannot tell whether or not they are
being looked after by a physician or a nurse practitioner and the reason behind this is the
development of advanced degrees for nurses (Jecker et. al, 1991, p. 292). Their educational level
was also a reliable indicator, but now a doctor will have an undergraduate and an MD while a
nurse might have a masters degree or even a research degree if they wish (Aiken, 2003). They
used to be well separated, and this simply does not exist anymore because physicians can
prescribe medicine to patients, but now so can nurse practitioners (Hain et. al, 2014). Both have
equal education, but they undergo different types of education since a doctor will be trained to
think more analytically while a nurse will be well rounded and specialize in clinical thinking
(Hain et. al, 2014). Author Julia Clarke on Perspectives on Learning says pity the poor nursing
student, who is required to write at times like a sociologist, at others like a philosopher, yet again
like a scientist and finally as a reflective practitioner given that the nurse would be more wellrounded due to variety in training (Clarke et. al, 2002, p. 10). Seeing as they are both very
educated and long for the high risk field of medicine, this needs to be proven to see if there really
is a difference in the way they think.
In this case how would a medical professionals writing skills impact patient care,
specifically doctors, nurses and medical assistants? As an interested researcher I wanted to
examine what these people think but without taking too much time out of their busy schedules
like an hour interview would. So I began to think about incorporating surveys due to the fact that

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they are very simple and require nothing more than 10 minutes of their time. A survey seemed to
be the most optimal solution concluding that this research would be more so quantitative than
qualitative.
Methods
In order to examine how healthcare professionals writing skills impact patient care, a
survey was administered to examine if the respondents exhibit their prior knowledge of assisting
patients and if they continue following specific guidelines that were taught in school ,such as
communicating with other healthcare professionals or incorporating their writing skills when
filling out patient charts. This will be concluded on physicians and nurses and the results of this
observation will inform fellow researchers and the hospital itself if these medical professionals
communicate efficiently and also follow up on each task they must perform.
The survey contained a mixture of ten multiple choice and free response questions that
had to do with how many years the person has been in the healthcare industry, how they would
rate their own writing skills and if writing skills should be just as important as communication.
Other questions ranged from how they would rate their own writing skills to if they believed that
they have used the information learned in English classes in any of the tasks in their day to day
lives in their career.
Findings
According to the 10 question survey that I administered both nurses and doctors
answered most of the questions but both of them answered in a different way. When it comes
down to it, both of these professionals were asked if they always make sure to follow up with
other healthcare partners on the tasks they performed and were given the possible answers yes,
no, and sometimes. In consonance to the survey 50% of the respondents answered sometimes
including the professional with the medical degree while the other 50% answered yes so this
research showed that medical professionals are much more likely to assume that orders will be

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carried out without further initiative then to provide reassurance. The reasoning behind this is
that if every single procedure done is written into the patient charts, then they will believe that
the next person handling the patient will be aware of what is happening. In reality, to make
matters a lot safer they should check back and make sure that what they ordered is being carried
out. A total of 21 healthcare professionals responded and 41% of the respondents had been in the
industry for over 10 years, and one participant had 43 years of experience. Since I was not able
to handpick all of the participants, I instead had a batch of multiple degrees: 37% of the
respondents had an associates degree in nursing; another 37% had a bachelors in nursing; and
even one doctor of medicine participated.
A small portion of the survey suggested that respondents include their past professions
before beginning their most recent career. Some participants chose to disclose their backgrounds
while others did not. Those who did respond and provide personal information had worked
various other professions before entering the medical field. For example the nurse who has a
masters in nursing, thesis program has been through many other careers such as a critical care
nurse, nursing Ed, nurse editor, and even consulting. Everyone had the question On a scale of 1
to 3 which do you think is most important: communicating effectively among patients,
incorporating proper writing skills when completing daily logs and patient history charts, and
following up tasks performed with other healthcare professionals and 50% of the respondents
had placed communicating effectively among patients as their first choice while the other 50%
placed incorporating proper writing skills into their daily routines. While the nurse who has the
masters degree in nursing labeled the answer incorporating proper writing skills as her first
choice, this could mean that with more and more experience comes more responsibility for their
actions done on a routine basis. Fortunately this person answered many other questions as well
unlike other respondents who decided to skip many of the more important questions. The same

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person rated their own writing skills a 1 from a scale of 1-5 and after being asked if he/she
believed that they have used the skills and information learned in prior English classes, the
participant responded with clear communication is vital in all aspects of care. I have always
tried to write clearly, succinctly, and accurately. This answer coming from someone who has a
vast amount of experience in the healthcare industry could mean that after so many years they
still incorporate the information learned in their daily lives.
Along with the most important questions in the survey one of them is writing skills
should be just as important as communication and thankfully everyone agreed. A majority of
people wrote that the most common error regarding communication among healthcare
professionals was medication errors for example missed or late doses and generally, the most
common errors are wrong drug, wrong dose, wrong patient, and wrong time as well. Due to the
research covered by the survey it allowed us to detect the reason why adverse events were
occurring following the medication errors.
Conclusion
Overall the people who had the most experience for example multiple professions in the
past and higher education levels had the most in depth opinions on the questions. They provided
more of a specific and detailed answer rather than just skipping questions. It was interesting to
see who would skip certain questions and out of all the people who saw this survey, only a small
portion decided to fill it out. Every single person had a different opinion on things but questions
that are taught in school, the respondents answered them correctly as they were once taught. So
the writing skill of a healthcare professional can and will affect the way a patient is treated
whether it be a wrong drug due to poor writing or the wrong time the drug is given. The
information recorded allows us to believe that they all exhibit their prior knowledge on their
daily routines while at work giving patients the satisfaction needed. The entire staff of medical

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assistants, physicians, registered nurses, and licensed practical nurses should definitely
incorporate everything that they have learned while in school into their daily routines, because
not doing so can create high risk zones. Not only can patients die from something so seemingly
small as poor writing but this can create horrible scenarios for families and give hospitals a bad
reputation, since they are supposed to be saving people and not causing harm.

References
Aiken, L. (2003, January 10). Educational levels of hospital nurses and surgical patient mortality.
Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=197345
Ash, J. (2003). Perceptions of physician order entry: Results of a cross-site
Qualitative study. Methods Inf Med, 42(4), 313, p. 23 Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/14534628
Fairman, J., Rowe, J., Hassmiller, S., & Shalala, D. (2010). Broadening the
Scope of nursing practice. The New England Journal of Medicine, (Vol. 10), 364, p. 193196. Retrieved, from http://www.nejm.org/doi/full/10.1056/NEJMp1012121
Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact
healthcare redesign. The Online Journal of Issues in Nursing, (Vol. 19), 2. Retrieved from
http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/T
ableofContents/Vol-19-2014/No2-May-2014/Barriers-to-NP-Practice.html
Harrison, R., & Clarke, L. (2002). Academic writing in new and emergent discipline areas. In
Supporting Lifelong Learning: Perspectives on Learning (Vol. 1). (Eds) London:
Routledge Falmer p. 10
Kohn, L., & Corrigan, J. (2000). To err is human: Building a safer health system. Journal of
Vascular and Interventional Radiology, (Vol. 6). P.112-113.
Jecker, N., & Self, D. (1991). Separating care and cure: An analysis of historical and
contemporary images of nursing and medicine. The Journal of Medicine and Philosophy, 16,

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285-306. Retrieved from file://fs01/profiles_students$/5002399904/Downloads/SeparatingCareAndCure.pdf

Reflection
This being the last paper I tried to incorporate as much information as possible with all of
research being done by me. In my opinion I really enjoyed this paper because of the fact that I
had to go ahead and record data on my own. At first I thought that I would make my way to one
of the local hospitals and do my research their but that failed when I wasnt even allowed to go
into the more important rooms because medical professionals are so busy most of the time. I then
found out about a website called survey monkey and made my own survey that fit well with my
paper. Since there wasnt much time to conduct research I took everybodys answers on the
questionnaire and incorporated them into the methods section instead of going to the hospital and
having a whole team of med professionals fill out the survey. In order to make this paper work I
kept the introduction and the literature review but I made some changes to it in order to fit the
whole paper. The methods section was completely re done and made to fit the responses of the
participants. I kept the same references because they were used for the literature review and I
saw no point in leaving them out.

Appendix
Question 1: How long have you been in the medical field?
Question 2: Tell me about your background as a medical professional.
Question 3: On a scale of 1 to 3 which do you think is most important? A) Communicating
effectively among patients. B) Incorporating proper writing skills when completing daily logs

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10

and patient charts. C) Following up tasks performed with other healthcare professionals such as
RNs (Registered Nurses), physicians, etc.
Question 4: Do you believe that you have correctly used the skills and information learned in
English classes taken in the past? If so which skill have you used the most in your career.
Question 5: How would you rate your own writing skills on a scale from 1-5 (with 1 being
exceptional and 5 being terrible)?
Question 6: What is your educational level?
Question 7: Do you witness medication errors with patients?
Question 8: If you do witness errors, what is the most common error that occurs?
Question 9: Writing skills should be just as important as communication. Agree or Disagree?
Question 10: After performing procedures and tasks do you always make sure to follow up with
other healthcare partners such as nurses or physicians?