Chapter 9 Quality Improvement and Professional Nursing Practice 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 systems 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 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 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 People Process Equipment Problem Materials Environment Management Quality Improvement Methodologies • “Plan, Do, Study, Act” • Six Sigma – Define, Measure, Analyze, Improve, Control • Swiss Cheese Model Act Plan Study Do 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
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