The Role Of Nurses In Improving Hospital Quality And Efficiency
There is considerable discussion in the healthcare field about what constitutes quality nursing care. For instance, the Institute of Medicine has defined quality care in terms of standards for populations and individuals that “increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” The IOM considers quality care synonymous with patient safety.
Similarly, the World Health Organization defines quality care as:
“the extent to which health care services provided to individuals and patient populations improve desired health outcomes.”
WHO maintains that to achieve these outcomes, healthcare should be effective, safe, efficient, timely, equitable, and peopled-centered.
Recognizing Quality Care
While most of us may not be able to articulate such an illustrious definition of quality care, we know it when we see it. As a nursing student, you will likely be introduced to lectures and literature that stress quality care. Once you graduate, you will likely strive to work for health care facilities that offer quality care. For that reason, it’s important that you understand what some of the parameters mentioned above should look like.
Effective care. Services should be based on scientific knowledge and evidence-based guidelines.
Safe care. Quality health care should minimize risks, harm to users. It should avoid preventable injuries and reduce medical errors.
Timely care. Delays in providing, receiving health care should be minimal.
Equal opportunity. Health care should not differ in quality depending on a person’s gender, ethnicity, race, geographical location, or socioeconomic status.
Efficient health care. Health care should be delivered in a way where waste is avoided and resources maximized.
People and culture centered. The health care should take into account the individual and cultural preferences and aspirations of the community that is being served.
Teaching Quality Care to Nursing Students
The American Association of Colleges of Nursing has led the way in enhancing nursing faculties’ ability to develop quality and safety competencies among nursing program graduates. Faculty development programs have been designed to train and improve curricula so that they can meet the standards of the core competencies listed above.
Fortunately, achievements in medicine and technology have contributed enormously to the quality of care. Nursing education has also improved along with these developments. Nursing educators recognize that continuous education goes hand in hand with improving the quality of nursing health care and patient safety.
Some of the issues and topics centered around quality care that nursing students might encounter in the classroom setting are as follows:
Treatment of wounds by offering timely diagnosis and evaluation
Focusing attention on patient needs in order to maintain safety, independence, recovery, or peaceful death
Basing nursing practices on systematic, planned, knowledge-based education and experience
Traceability of medical procedures
Offering patient education, motivation, monitoring, and early recognition of causes and risk factors
Reducing or removing causes and risk factors of health issues through necessary, safe medical treatment
Maintenance and optimization of health status, as well as prevention of complications from existing diseases and conditions
Appropriate wound treatment that increases satisfaction, reduces pain, increases mobility, reduces aggravating factors, and achieves a satisfactory outcome
Scientific research and knowledge about pathology of wound formation and healing
Modern achievements that accelerate independence, reduce pain, encourage faster wound healing
Practices that develop awareness, knowledge, and relevant experience
Training for a Nursing Career
Continuous nursing education, leading to an associate’s degree and beyond, will give you the opportunity to improve your understanding of quality care, so that you are able to deliver it throughout your career. For instance, an associate’s degree should help you develop these capabilities, which will, in turn, enhance your ability to deliver quality care:
Contributing to an interdisciplinary health care team
Effective collaboration in health care settings with individuals, families, communities
Executing best practices from health care disciplines to provide competent, safe, effective care
Holistic care to promote and improve safety outcomes in multicultural and diverse settings
Determination of appropriate prevention and health promotion tactics, contributing to quality care
Integration of information management and technology in quality care
Demonstration of effective leadership
Discussions & Policy Implications
Hospitals need to integrate their work to improve quality and patient-centeredness and to increase the efficiency of care delivery. Nurses and other front-line staff must play key roles. To benefit from the insight and input of these staff members, hospitals will need to value their potential contributions, shifting their vision of nursing from being a cost center to being a critical service line.
But simply changing leadership’s view of front-line staff or changing hospital culture to embrace a culture of improvement will be insufficient. One of the lessons we draw from the TCAB experience is that improvement must be institutionalized in the day-to-day work of the front-line staff, with adequate time and resources provided and with front-line staff participating in decision making.
The experience of Magnet hospitals and of units engaged in TCAB provide concrete models of the hospital- and unit-level organizations and processes to accomplish this. Increasingly, there are organized vehicles for promoting these models, including the Magnet accreditation program, IHI and AONE plans to promote TCAB models in their ongoing work, and the RWJF’s ongoing support of this program at the state and national levels.
These specific activities need to be complemented with other changes that encourage the engagement of front-line staff in process improvement. These should include changes in reimbursement to increase the value of effective, high-quality nursing to hospitals, such as the recent decision by the Centers for Medicare and Medicaid Services to not pay for “never events.” There is a growing literature on nursing-sensitive payment.
Looking upstream from the hospital, nursing education will have to change to prepare new graduates to work in environments where they have responsibility for process improvement. One model showing promise is that of Clinical Nurse Leaders, an effort to produce nursing school graduates who can implement outcomes-based practice and quality improvement strategies and create and manage unit-level systems for delivering care.
Getting nurses and other front-line staff actively involved in efforts to simultaneously improve hospital quality and increase efficiency will require action both within institutions and by those who measure their quality and pay for their services.
The models for accomplishing this are still evolving, but the broad outlines for achieving such engagement are clear. The lessons from Magnet accreditation and TCAB should be used as hospitals take full advantage of nurses’ knowledge and commitment to their patients and institutions — to increase the safety and reliability, patient-centeredness, and efficiency of care.