Discussion Question
1- Discussion question: Describe nursing-sensitive measurements and why they are important in Nursing care delivery.
2- 3 paragraphs 3 sentences each.
3- 2 references not older than 2015
4- APA style
Quality
Improvement
and Professional
Nursing Practice
Chapter 9
Healthcare Quality (1 of 2)
Quality is the degree to which health services
for individuals and populations increase the
likelihood of desired health outcomes and are
consistent with current professional knowledge
Healthcare Quality (2 of 2)
Quality improvement refers to the use of data
to monitor the outcomes
of care
processes, and
uses improvement methods to design and test
changes to continuously improve the quality and
safety of healthcare
system
s
Crossing the Quality Chasm (IOM, 2001)
• Safe, timely, effective, efficient, equitable, and
patient-centered (STEEEP)
• 10 rules for redesign to move the healthcare
system toward the identified performance
expectations
10 Rules for Redesign (1 of 3)
• Care is based on continuous healing relationships
with patients receiving care whenever and wherever
it is needed
• Care can be customized according to the patient’s
needs and preferences even though the system is
designed to meet the most common types of needs
• The patient is the source of control and as such,
should be given enough information and opportunity
to exercise the degree of control he or she chooses
regarding decisions that affect him or her
10 Rules for Redesign (2 of 3)
• Knowledge is shared and information flows freely
so that patients have access to their own medical
information
• Decision making is evidence based; that is, it is
based on the best available scientific knowledge
and should not vary illogically between clinicians
or locations
• Safety is a system property and patients should be
safe from harm caused by the healthcare system
10 Rules for Redesign (3 of 3)
• Transparency is necessary where systems make
information available to patients and families that
enable them to make informed decisions when
selecting a health plan, hospital, or clinic, or when
choosing alternative treatments.
• Patient needs are anticipated rather reacted to
• Waste of resources and patient time is continuously
decreased
• Cooperation among clinicians is a priority to ensure
appropriate exchange of information and coordination
of care
Healthcare Transparency (1 of 2)
• Medicare’s Hospital Compare at:
www.hospitalcompare.hhs.gov
• Medicare’s Home Health Compare at:
https://www.medicare.gov/homehealthcompare/
• Quality Check’s Find a Health Care
Organization at: http://www.qualitycheck.org/
consumer/searchQCR.aspx
• The Leapfrog Group’s Hospital Safety Score at:
http://www.hospitalsafetyscore.org
http://www.hospitalcompare.hhs.gov
https://www.medicare.gov/homehealthcompare/
http://www.qualitycheck.org/consumer/searchQCR.aspx
http://www.qualitycheck.org/consumer/searchQCR.aspx
http://www.hospitalsafetyscore.org
Healthcare Transparency (2 of 2)
• America’s Health Rankings by the United
Health Foundation at:
http://www.americashealthrankings.org
• Improving Healthcare for the Common Good
(IPRO) at: http://ipro.org/for-consumers
• IPRO’s Why Not the Best? at:
http://www.whynotthebest.org
• The Commonwealth Fund at:
http://www.commonwealthfund.org
http://www.americashealthrankings.org
http://www.whynotthebest.org
http://www.commonwealthfund.org
Measures of Quality
• Benchmarking
• Core measures
• Accountability
• Composite measures
Measures of Nursing Care
• Consumer Assessment of Healthcare Providers
and Systems (CAHPS) Hospital Survey
• National Voluntary Consensus Standards for
Nursing-Sensitive Care
• National Database of Nursing Quality
Indicators (NDNQI)
Continuous Quality Improvement (CQI)
Structured organizational process that involves
personnel in planning and implementing the
continuous flow of improvements in the
provision of quality health care that meets or
exceeds expectations
Processes or Pathways for CQI
• First process occurs as data that is regularly
collected is monitored; if the data indicate that a
problem exists, then an analysis is done to
identify possible causes and a process is
initiated to pilot a change
• Second process involves the identification of a
problem outside of the routine data monitoring
system
Example Fishbone Diagram
Problem
Management Environment
Equipment Process People
Materials
Quality Improvement Methodologies
• “Plan, Do, Study,
Act
”
• Six Sigma
– Define, Measure,
Analyze, Improve,
Control
• Swiss Cheese Model
Plan
DoStudy
Act
American Nurses Association (ANA)
Standard #10
ANA standard of professional performance: The
registered nurse contributes to quality nursing
practice with competencies that include the
nurse’s role in various quality improvement
activities such as collecting data to monitor
quality and collaboration to implement quality
improvement plans and interventions
Challenges
• Adequacy of resources
• Engaging nurses from management to the
bedside in the process
• Increasing number of QI activities
• Administrative burden of QI initiatives
• Lack of preparation of nurses in traditional
nursing education programs for role in QI