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 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 patients
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)
Medicares Hospital Compare at:
www.hospitalcompare.hhs.gov
Medicares Home Health Compare at:
https://www.medicare.gov/homehealthcompare/
Quality Checks Find a Health Care
Organization at: http://www.qualitycheck.org/
consumer/searchQCR.aspx
The Leapfrog Groups 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)
Americas 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
IPROs Why Not the Best? at:
http://www.whynotthebest.org
The Commonwealth Fund at:
http://www.commonwealthfund.org
http://www.americashealthrankings.org
http://ipro.org/for-consumers
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
nurses 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
