Variations in Practice
Variations in practice, sometimes
referred to as fragmented care, can be
found at the hospital systems level.
The physical design of the organization
and the inaccessibility to updated
technology, such as diagnostic
equipment and user-friendly medical
records, can be sources of fragmented
care. Variations can occur as a result
of ineffective organizational leadership,
the shortage of experienced
interprofessional teams, and poor
communications among health care
providers. Issues related to medical
coverage and services (e.g., access to
insurance and medical services;
high deductibles and co-pays) and
the research-practice gap (e.g., lack
of organizational culture for research
implementation; nurse preparedness
and willingness to participate
in research) also contribute to
fragmented care. Patients are affected
by variations in all these dimensions.
In addition, variations in
practice play a significant role in
health care cost. Nurse leaders at the
bedside can minimize costs by implementing
evidence-based practices
and eradicating fragmented
care (IOM, 2001).
Clinical leaders at the bedside
recognize sources of fragmented
care and use structured approaches
to eliminate them. These leaders
implement evidence-based policies,
protocols, and pathways, and share
evidence-based and best practices
with nurse colleagues. They advo