Improving Quality

Improving the quality of health care delivery and patient safety continues to be a political concern and has been at the heart of reform issues for many years. The American Nurses Association (ANA) and the Institute of Medicine (IOM) have increased awareness of health care quality and safety issues, as well as advocated for health care reform. The documents featured at the ANA and IOM websites listed in this week’s Learning Resources focus on many of the current issues surrounding quality and safety in the health care industry.

To prepare:

• Review this week’s Learning Resources, focusing on the Six Aims for Improvement presented in the landmark report “Crossing the Quality Chasm: The IOM Health Care Quality Initiative.”
• Consider these six aims with regard to your current organization, or one with which you are familiar. In what areas have you seen improvement? What areas still present challenges? As a nurse leader, how can you contribute to improving the organization’s achievement of these aims?
• Select one specific quality or safety issue that is presenting a challenge in the organization. Consider at least one quality improvement strategy that could be used to address the issue, as well as which of the six aims for improvement would then be addressed.
• Reflect on your professional practice and your experiences with inter-professional collaboration to improve quality and safety. How has inter-professional collaboration contributed to your organization’s efforts to realize the IOM’s six aims for improving health care? Where has inter-professional collaboration been lacking?

Post by Day 3 a description of the quality or safety issue you selected and a brief summary of the impact that this issue has on health care delivery. Describe at least one quality improvement strategy used to address this issue. Then explain which of the six “aims for improvement” are addressed by the strategy. Finally, explain how inter-professional collaboration helps improve quality in this area.

Required Resources

Readings

• Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the united states (11th ed.). New York, NY: Springer Publishing.
  • Chapter 13, “High Quality Health Care” (pp. 273-295)
  • Chapter 2, “A Visual Overview of Health Care Delivery in the United States” (pp. 13-27)

    These chapters discuss the current state of health care quality, as well as efforts to measure and improve quality.

  • Chapter 14, “Managing and Governing Health Care Organizations” (pp. 297-309)

    This chapter details the vital importance of developing a better understanding of why and how heath care organizations are governed and managed in order to improve accountability.

• Berwick, D. (2005). My right knee. Annals of Internal Medicine, 142(2), 121–125.
  Retrieved from the Walden Library databases.

  In this article, Donald Berwick describes five specific dimensions of “total quality” care he will need when his right knee is replaced; however, he feels no one health care institution can deliver all five dimensions.

• Gardner, D. (2010). Health policy and politics. Expanding scope of practice: Inter-professional collaboration or conflict? Nursing Economic$, 28(4), 264–266.
  Retrieved from the Walden Library databases.

  This article summarizes the interdisciplinary conflict and collaboration likely to be promoted by the Patient Protection and Affordable Care Act. The text emphasizes the value of mediators in facilitating discussions between thought leaders from different disciplines.

• Solomon, P. (2010). Inter-professional collaboration: Passing fad or way of the future? Physiotherapy Canada, 62(1), 47–55.
  Retrieved from the Walden Library databases.

  This lecture highlights challenges to collaborative practice in clinical settings. In addition, the author presents strategies for influencing an environment to be more collaborative.

• Agency for Healthcare Research and Quality. (n.d.). Model public report elements: A sampler. Retrieved from http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/value/pubrptsampler/pubrptsampler.pdf

  This web page defines the six domains that are important for health care quality. The goals of the six domains in health care to be safe, effective, patient-centered, timely, efficient, and equitable.

• American Nurses Association. (n.d.) Expert policy analysis. Retrieved March 22, 2012, from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs

  This web page explores ANA’s Department of Nursing Practice and Policy efforts with internal policy decisions and nursing’s input on external policy.

• American Nurses Association. (n.d.) Health care policy. Retrieved March 22, 2012, from http://www.nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues.aspx

  This web page informs about nurses’ firsthand experiences in effecting health care laws and regulations through ANA’s principles.

• American Nurses Association. Health system reform. Retrieved March 22, 2012, from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/HealthSystemReform
  
  This web page details health reforms impact on health care delivery.
• Berwick, D. (2002). Escape fire: Lessons for the future of health care. Retrieved from http://www.commonwealthfund.org/usr_doc/berwick_escapefire_563.pdf

  This influential speech, given by Dr. Donald Berwick in 1999, uses the analogy of starting a fire to escape a fire as a way to detail the challenges the health care industry faces in improving the quality of care and safety.

• Federal Register. (2011). Retrieved from http://www.gpo.gov/fdsys/browse/collection.action?collectionCode=FR

  This website houses the official daily publication of rules, proposed rules, and notices of federal agencies and organizations, including executive orders and presidential documents.

• Institute of Medicine of the National Academies. (2012). Crossing the quality chasm: The IOM Health Care Quality Initiative. Retrieved from
  http://www.iom.edu/Global/News%20Announcements/Crossing-the-Quality-Chasm-The-IOM-Health-Care-Quality-Initiative.aspx

  The Institute of Medicine provides a Quality Initiative to document the seriousness of the quality problem and assesses the ongoing effort to improve the nation’s quality of care.

• National Quality Forum (2007). Tracking NQF-endorsed consensus standards for nursing-sensitive care: A 15-month study. Washington, DC: National Quality Forum. Retrieved from http://www.qualityforum.org/Projects/s-z/Tracking_Nursing-Sensitive_Care_Consensus_Standards_%282007%29/Tracking_Nursing-Sensitive_Care_Consensus_Standards.aspx

  This report provides full detail of the first comprehensive effort to evaluate the degree NQF-endorsed standards for nursing-sensitive care have been implemented.

• National Quality Forum. (2012). Retrieved from http://www.qualityforum.org/Home.aspx

  The National Quality Form project identifies outcome, process, and structural measures, as well as patient experience of care in order to specifically address quality improvement.

Media

• Laureate Education, Inc. (Executive Producer). (2012i). Quality improvement and safety. Baltimore, MD: Author.

  Note: The approximate length of this media piece is 14 minutes.