As a child, Maureen Falcone remembers tagging along with her mom as they dropped her grandfather off for his 9 a.m. appointment at the VA hospital. After driving into town from several hours away, they’d run errands during the day before returning to pick him up at 4 p.m. Sometimes, though, the VA was so busy that her grandfather wasn’t able to be seen that day, leaving them to return another day in the hopes that he’d be able to receive care.
“Everybody had the same appointment time,” Falcone said. “You showed up and they took you in order and when they got done, they got done. It was very frustrating because sometimes even though you had an appointment, you might not even get seen that day.”
Many years later, in her current role as practice excellence coordinator at the John J. Cochran Veterans Hospital, Falcone is proud that she and her colleagues have improved access to care for veterans through the use of evidence-based practice. In 2022, she earned her PhD in Nursing from the College of Nursing at the University of Missouri–St. Louis, and is using that knowledge to refine practices to improve care for veterans across the region.
“We’re really focused on quality of care and timely care, making sure that they’re getting what they need so that they don’t have to go outside of the VA for care,” she said. “What I love about working for the VA is that so many people are here to improve veteran care. Over 30% of our employees at the St. Louis VA are veterans, so we all come with this passion for helping veterans and improving the quality of care. It’s not the same VA that maybe your grandparents went to. We’ve really become a leader in health care. I’m very proud that we can give back to our veterans who have provided for us.”
Improving care for patients
Falcone’s grandfather, who served in the military in both World War I and II, inspired her to serve herself. She enrolled in the Army National Guard in 1981, intending to stay six years, but wound up serving for 10. Although there weren’t many women in the military when she first enrolled, she loved challenging herself, learning a mission and working as a team. She started in communications and, after earning her BSN in 1985, began setting up CPR programs and conducting MASH hospital trainings in several states. She said the experience prepared her well for her eventual career in nursing, as it helped her both develop her own skills and learn to teach others.
“It really helped me mentally know that I can do anything that I put my mind to,” she said. “It really gives you a lot of self-confidence. It helps you think through things in a systematic and strategic way, identifying goals and breaking those down into timelines and achieving them. They’re very process-oriented and so it’s very logical, repeatable and standardized; there’s policy and process for everything.”
After leaving the army as an officer, Falcone worked as a critical care nurse for many years, including several years at a large teaching hospital in Nebraska. She then moved to St. Louis, where she worked in critical care at a few community hospitals as well as BJC HealthCare. Here, she was asked to take on a role as quality improvement specialist – a path she hadn’t yet considered.
“Once I was in that area, I understood how the quality of care is so important,” she said. “Not just in what I provide as a nurse at the bedside, but for us to be able to keep the doors open at the hospital. It’s making sure that we have good strategies for infection prevention and good practice on evaluating ourselves on quality, metrics, mortality, 30-day readmissions, length of stay – looking at some of that data to say where are we and how can we improve on those areas where we have opportunities?”
Falcone combined her newfound interest in quality of care with many years of critical care bedside experience and soon became the hospital’s STEMI coordinator, focused on reducing heart attacks. As she got more exposed to the importance of improving care, she started getting involved at the state level on a few regional task forces aimed at improving quality of care for all Missourians. “I was able to take the things that I learned from that back to the hospital and back to our staff so that we can all benefit together,” she said. “I can learn from them, they can learn from what I know, and we can make wherever we’re working better for our patients.”
With an eye toward improving care for veterans, Falcone moved to the John J. Cochran Veterans Hospital as a critical care educator nearly eight years ago. Now, in her current role as practice excellence coordinator, she helps VA nurses in St. Louis improve their practice through evidence-based care by gathering, synthesizing and analyzing data to make recommendations.
Part of that work involves shared governance councils, which Falcone said affords frontline staff a voice in improving practice. She also works directly with nursing leaders who can share quantitative data about efforts to improve practice, such as reducing infections, medication errors and other adverse events. The VA recently finished training 40 new nurses on being champions for preventing pressure injuries, for instance, and Falcone said they’re already seeing a reduction in pressure injuries in their patient population.
“We’re really basing it off of current evidence and research instead of just the way we’ve always done things,” she said. “We’re moving our culture from the old VA way to making sure that it’s current, updated evidence-based practice. I feel very fortunate that I get to work with a lot of nurses and help improve practice and outcomes for our veterans.”
Strengthening communication between providers
Falcone also stressed that improving quality of care and reducing harm goes hand in hand with improving communication within the health care system. According to the TJC, more than 70% of medical errors can be attributed to communication problems, and Falcone has become interested in understanding how to improve communication and potentially prevent those errors, leading to better care for patients.
“What we know is that there are multiple factors involved in adverse event reporting,” she said. “We know that we’re supposed to report things – when we see something, we’re supposed to say something. But if we don’t have an environment that’s supportive of that – sometimes if there’s not psychological safety and other organizational support for that – then people may be reluctant to report errors or to do so if they can’t do it anonymously.”
That’s an area Falcone explored during her PhD program at UMSL. Specifically, she looked at how factors of adverse event reporting align with guiding principles for high reliability organizations, such as the airline industry, which have a high risk for catastrophic events if errors occur.
“Unfortunately, what we often have fallen back on when we identify a problem is to just teach them about what the problem is and tell them what they’re supposed to do,” she said. “But we need to listen to nurses about why they’re not reporting events. I wanted to see if we identify those things, could we possibly move the needle on improving error reporting and improve patient care. We can’t fix something if we don’t know what the problem is.”
In 2022, along with UMSL faculty members Kimberly Werner, Anne Fish and Umit Tokac in the College of Nursing and Stephanie Van Stee in the Department of Communication and Media, she published a comprehensive review of literature on adverse event reporting in the Journal of Patient Safety. The review found the greatest barriers to adverse event reporting to be perceptions of fear of blaming and retaliation, lack of feedback and comfort level of challenging someone more powerful.
This past August, the same group also published “Factor Structure and Construct Validity of a Hospital Survey on Patient Safety Culture Using Exploratory Factor Analysis,” in the Journal of Patient Safety. The paper synthesized research conducted during Falcone’s PhD program and made recommendations for care, which Falcone is excited to potentially implement in the VA system to offer better care for veterans. Moving forward, she hopes to continue using her role at the VA and the knowledge gleaned in UMSL’s PhD program to improve communication among health care providers and, in turn, improve care for patients.
“There are really so many things that we can do to improve communication and patient safety,” she said. “I think nurses are at the forefront of that because they’re the ones providing the care and they are the gatekeepers for safe care and for communication. If we can focus on how we can improve that for them, we’ll be able to improve patient care and reduce harm.”