When she started talking about this dirty little secret, no one else was acknowledging that healthcare culture could and should change. And yet the Institute for Healthcare Improvement clearly stated that the greatest barrier to patient safety is culture.
"At the time, there were only a few articles on this topic," she says. "It was not at all a priority anywhere. No one saw the impact and no one had demonstrated the impact."
Bartholomew focuses on the critical importance for healthcare to learn how to create collegial teams, just as has been done in other professions, such as aviation and nuclear power.
"Until we get there, patients will never be safe," says Bartholomew. "Allowing one person to behave badly undermines trust. You can't have collegial teams without trust and everyone on board. An institution cannot have integrity when there are different rules for different roles."
"We will look back in 20 years and wonder how we possibly thought we could deliver care when the physician doesn't think it's necessary to read the nurse's notes or even speak to the nurse," she says. "It's absurd that two people delivering care are not required to communicate."
Bartholomew now works on delivering her message to all levels across healthcare, from staff nurses to boards of directors.
"Right now, I'm thrilled to be able to have an impact on a much larger scale," she says. "I speak to boards of directors at hospitals and get to spend a whole day explaining culture and the impact of that culture on quality and safety. I teach them about nurse-to-nurse and physician-to-nurse communication and it's been profound. Boards are now adopting behavior rules. Now senior nurses are being given the clout they need from the boards of directors. They are saying, 'It doesn't matter how much money that physician brings in, he screamed at and demeaned the nurse!'"