AS175-01 April 9, 2003 14:27 Char Count= 0 Nurs Admin Q Vol. 27, No. 2, pp. 95–105 c  2003 Lippincott Williams & Wilkins, Inc. Rebuilding a Professional Practice Model The Return of Role-based Practice Accountability Maria Williams O’Rourke There is no patient care without clinical practice. To improve the quality of health care, organiza- tions must build a finely tuned and resilient clinical enterprise, one founded on clear role account- ability and decision authority within the team. The author views scope of practice and professional standards as the foundation for practice accountability and decision authority. A case is made that an interdisciplinary, professional practice model is an appropriate delivery model in today’s health care environment; a model that places the professional role in its rightful place as decision maker and supports the role’s inherent accountability to evaluate and monitor practice performance. The importance of measuring professional practice performance is seen as a key link toward better un- derstanding ways to reduce error and ensure patient safety. Key words: interdisciplinary collab- oration, organizational development, patient safety, performance measurement, professional practice, role accountability, scope of practice and standards M ANY VOICES over the past decade sig- naled a concern about the direction of the health care industry, the value or efficacy of the care models being promoted, and their impact on patient care and care delivery. 1–3 By the end of the 1990s the Institute of Medicine study, “To Err Is Human,”brought to the na- tion’s attention some of the ills of our health care system. 4 In particular, the study reported that the error rate in hospitals was alarming and that serious attempts by all stakehold- ers was required if we were to reverse this industry trend. This triggered a national re- sponse by consumers, employers, and pur- chasers of services, each for different reasons, who demanded reform that would ensure pa- tient safety. This begs the question: Where does one look to find out what is contributing to such a dangerous situation? One approach From O’Rourke & Associates, Larkspur, California. Corresponding author: Maria Williams O’Rourke, Presi- dent and CEO, O’Rourke & Associates, PO Box 512, Lark- spur, CA 94977. is to examine how we practice whether as individuals, as a team or as an organization. Figure 1 displays the dynamic practice rela- tionships that exist within an organization and helps us to better understand the impact of practice performance on outcomes. In this model there are three kinds of practice: orga- nizational, team, and individual. 5 These rep- resent separate and interdependent ways of practicing that creates an interlocking system of thinking; the basic premise is that careful examination of the way we “think and prac- tice together” will help us to better under- stand how practice performance is related to improving outcomes and reducing error. ORGANIZATIONAL PRACTICE Over the past decade many organizations have been focused on reengineering their work environments in an attempt to reduce cost. As a result of this effort many institu- tions have made significant changes in orga- nizational practice, such as initiating staff re- ductions and changing skill mix. However, a 95