Changing the work environment in ICUs to achieve patient-focused care: the time has come

The American Association of Critical-Care Nurses (AACN) Standards for Establishing and Sustaining Healthy Work Environments and the American College of Chest Physicians (ACCP) Patient-Focused Care Project are complementary initiatives that provide a road map for creating practice environments where interdisciplinary, patient-focused care can thrive. Healthy work environments are so influential that failure to address the issue would result in deleterious effects for every aspect of acute care and critical care practice. Skilled communication and true collaboration are crucial for transforming work environments. The ACCP project on patient-focused care was born out of a realization that medicine as currently practiced is too fragmented, too focused on turf battles that hinder communication, and too divorced from a real understanding of what patients expect and need from their health-care providers. Communication as well as continuity and concordance with the patients' wishes are the foundational premises of care that is patient-focused and safe. Some individuals may achieve some level of genuine patient-focused care even when they practice in a toxic work environment because they are gifted communicators who embrace true collaboration. At best, those efforts will most likely be hit-or-miss, and such heroism will be impossible to sustain if the environment is not transformed into a model that reflects the standards and initiatives set out by the AACN and the ACCP. Other innovative models of care delivery remain unreported. The successes and failures of these models should be shared with the professional community.