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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 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://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

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