Building a culture of excellence in Boston and beyond

There is mounting evidence that unhealthy work environments result in dissatisfied staff, breakdown in communication among disciplines, and poor patient outcomes. 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 were developed as complementary initiatives to provide direction for improving patient care environments. Hospitalized pediatric patients benefit from interdisciplinary collaboration, teamwork, and clinical innovation that are not obstructed by disciplinary silos and rigid roles. AACN's 6 evidence-based standards are used as a framework to guide this discussion about cultures of excellence in pediatric cardiovascular programs through the lens of an experienced nurse administrator. Each standard interacts in a dynamic way to promote clinical and operational excellence for optimal patient outcomes. Evidence-based examples of contemporary interdisciplinary practice from pediatric cardiovascular centers are described for each of the standards. The 2010 results from the AACN Healthy Work Environment Survey for the cardiovascular program at Children's Hospital Boston are documented. The AACN standards are aligned as a foundation for assessment and improvement of pediatric professional practice environments. Implementation of the standards may be helpful in achieving a culture of excellence in pediatric cardiovascular centers. Monitoring the standards across programs and organizations may be accomplished through the AACN Healthy Work Environment Survey.