Quality and Safety

Quality and Safety
Some is not a number. Soon is not a time.
—Slogan for the completed 100,000 Lives Campaign and 5 million Lives Campaign from the
Institute for Healthcare Improvement (IHI)
As reflected in the IHI statement above, safeguarding patients and promoting high-quality care
requires more than vague promises. Although sensational headlines highlighting unsafe or
inadequate care have brought increasing public attention to troubling events, providers,
government agencies, insurers, and nonprofit organizations have taken strides to promote greater
transparency and accountability around these issues. Reimbursements from government sources
of funding and private insurers have been directly linked to performance through measures of
safety and quality. In addition, many groups now acknowledge the need to improve the culture of
care and are seeking ways to facilitate inter-professional collaboration that places concern for the
patient at the center of health care delivery. As a nurse leader, you can play an integral part in
promoting high-quality care and upholding the safety of patients, as well as of health care
workers.
This week, you will examine the six aims promoted by the Institute of Medicine for improving
health care. You will also consider the value of inter-professional collaboration in addressing
health care issues.
Reference:
Overview of the 100,000 Lives campaign. Retrieved from
http://www.ihi.org/offerings/Initiatives/PastStrategicInitiatives/5MillionLivesCampaign/Documents/Overview%20of%20the%20100K%20Campaign.pdf
Learning Objectives
Students will:
•
Analyze the impact of quality and safety issues on health care delivery
•
Analyze the value of inter-professional collaboration for improving health care quality and safety
Photo Credit: Angela Schmidt/iStock/Getty Images
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course
Readings List, found in the Course Materials section of your Syllabus.
Required 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://archive.ahrq.gov/professionals/quality-patient-safety/qualityresources/value/pubrptsampler/pubrptsampl2b.html#Presentation
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 August 30, 2018,
from https://www.nursingworld.org/practice-policy/nursing-excellence/official-positionstatements/expert-policy-analysis/
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 August 30,2018, from
https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/
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
https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_
other_2002_nov_escape_fire__lessons_for_the_future_of_health_care_berwick_escapefire_563_
pdf.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. (2001). Crossing the quality chasm: The IOM
Health Care Quality Initiative. Retrieved from
http://www.nationalacademies.org/hmd/Global/News%20Announcements/Crossing-the-QualityChasm-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 nursingsensitive care: A 15-month study. Washington, DC: National Quality Forum. Retrieved from
http://www.qualityforum.org/Projects/s-z/Tracking_NursingSensitive_Care_Consensus_Standards_%282007%29/Tracking_NursingSensitive_Care_Consensus_Standards.aspx
This report provides full detail of the first comprehensive effort to evaluate the degree NQFendorsed 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.
Required Media
Laureate Education (Producer). (2012i). Quality improvement and safety. Baltimore, MD:
Author.
Note: The approximate length of this media piece is 14 minutes.
Accessible player
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 interprofessional collaboration been lacking?
write 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.
Critical Thinking, Reading, and Analysis
Learning Objectives
Students will:
•
Explain the relationship between critical thinking and clinical competency
•
Analyze the connection between critical thinking, clinical competence, and scholarship
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course
Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Berkow, S., Virkstis, K., Stewart, J., Aronson, S., & Donohue, M. (2011). Assessing individual
frontline nurse critical thinking. Journal of Nursing Administration, 41(4), 168–171.
doi:10.1097/NNA.0b013e3182118528.
Note: You will access this article from the Walden Library databases.
The authors of this article developed a tool to assess 25 critical thinking skills deemed necessary
for frontline nurses.
Jenkins, S. (2011). Cross-cultural perspectives on critical thinking. Journal of Nursing
Education, 50(5), 268–274. doi:10.3928/01484834-20110228-02.
Note: You will access this article from the Walden Library databases.
This article seeks to further define common characteristics of critical thinking by exploring the
influence of culture on its definition. They compare nursing students’ perceptions of critical
thinking from the United States with Thailand.
Zori, S., Nosek, L. J., & Musil, C. M. (2010). Critical thinking of nurse managers related to staff
RNs’ perceptions of the practice environment. Journal of Nursing Scholarship, 42(3), 305–313.
doi:10.1111/j.1547-5069.2010.01354.x
Note: You will access this article from th

References:

Nursing Standards

Nursing and Midwifery Board of Australia. (2018). Code of conduct for midwives. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Clinical Guidelines

Guideline Adaption Committee. (2016). Clinical practice guidelines and principles of care for people with dementia. NHMRC Partnership Centre for Dealing with Cognitive and Related Function Decline in Older People. https://cdpc.sydney.edu.au/wp-content/uploads/2019/06/CDPC-Dementia-Guidelines_WEB.pdf

Living Guideline

Stroke Foundation. (2022). Australian and New Zealand living clinical guidelines for stroke management – chapter 1 of 8: Pre-hospital care. https://app.magicapp.org/#/guideline/NnV76E

Evidence-based practice

BMJ Best Practice

Goldfarb, S., & Josephson, M. (2020). Cystic fibrosis. BMJ Best Practice. https://bestpractice.bmj.com/

Schub, T., & Cabrera, G. (2018). Bites: Head lice [Evidence-based care sheet]. Cinahl Information Systems. https://www.ebscohost.com

Beyea, S. C., & Slattery, M. J. (2006). Evidence-based practice in nursing: A guide to successful implementation. http://www.hcmarketplace.com/supplemental/3737_browse.pdf

JBI: Evidence summary

Swe, K. K. (2022). Blood glucose levels: Self-monitoring [Evidence summary]. JBI EBP Database. https://jbi.global

JBI: Best practice information sheet

Bellman, S. (2022). Experiences of living with juvenile idiopathic arthritis [Best practice information sheet]. JBI EBP Database, 24(1), 1-4.

Cochrane Database of Systematic Reviews

Srijithesh, P. R., Aghoram, R., Goel, A., & Dhanya, J. (2019). Positional therapy for obstructive sleep apnoea. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD010990.pub2

Drug Information

Codeine. (2023, January). In Australian medicines handbook. Retrieved February 2, 2023, from https://amhonline.amh.net.au

Colorado State University. (2011). Why assign WID tasks? http://wac.colostate.edu/intro/com6a1.cfm

 

Dartmouth Writing Program. (2005). Writing in the social sciences. http://www.dartmouth.edu/~writing/materials/student/soc_sciences/write.shtml

Rutherford, M. (2008). Standardized nursing language: What does it mean for nursing practice? [Abstract]. Online Journal of Issues in Nursing, 13(1). http://ojin.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Health-IT/StandardizedNursingLanguage.html

Wagner, D. (n.d.). Why writing matters in nursing. https://www.svsu.edu/nursing/programs/bsn/programrequirements/whywritingmatters/

Writing in nursing: Examples. (n.d.). http://www.technorhetoric.net/7.2/sectionone/inman/examples.html

Perth Children’s Hospital. (2022, April). Appendicitis [Emergency Department Guidelines]. Child and Adolescent Health Service. https://www.pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Appendicitis

Department of Health. (n.d.). Who is being active in Western Australia? https://ww2.health.wa.gov.au/Articles/U_Z/Who-is-being-active-in-Western-Australia

Donaldson, L. (Ed.). (2017, May 1). Healthier, fairer, safer: The global health journey 2007-2017. World Health Organisation. https://www.who.int/publications/i/item/9789241512367

NCBI Bookshelf

Rodriguez Ziccardi, M., Goyal, G., & Maani, C. V. (2020, August 10). Atrial flutter. In Statpearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK540985/

Royal Perth Hospital. (2016). Procedural management: Pre and post (24-48 hours) NPS. Canvas. https://courses.ecu.edu.au

 

 

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