24 May nursing 9
Quality Improvement and Professional Nursing Practice
Chapter 9
1
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/
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
Quality Improvement Methodologies
“Plan, Do, Study, Act”
Six Sigma
Define, Measure, Analyze, Improve, Control
Swiss Cheese Model
Plan
Do
Study
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
Problem
Management Environment
Equipment Process People
Materials
Problem
Management
Environment
Equipment
Process People
Materials
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