Improving Quality Care

Kimberly Kuttner

Quality Improvement

Santa Fe College

Quality Improvement

Improving quality care has always been one of the motives for health care providers as early as the 1860’s (Kovner, Brewer, Yingrengreung, & Fairchild, 2010). Florence Nightingale was one of the pioneers in nursing and used a new technique at the time of statistical analysis of preventable deaths in the military during the Crimean War (Audain, 2014). Nightingale collected data and showed calculations of how the mortality rate would decrease with improved sanitary methods (Audain, 2014).  This is an example of how statistics can provide a structured way of learning from current or past practice and creates quality improvements in medical and surgical practices. Quality improvement (QI) requires all employees (including management and bedside RNs) to be proactive and planning oriented for problem solving (Cherry & Jacobs, 2011). It is important for nurses to be able to notice what needs improvement on their unit and use critical thinking as a group to find a solution.

QI began to get most patients’ and health care providers’ attention when the Institute of Medicine (IOM)’s report To Err is Human came out in 2000 (Kovner, Brewer, Yingrengreung, & Fairchild, 2010). It was later reinforced in 2004 with Patient Safety: Achieving a New Standard for Care, which included the following quality aims for healthcare systems: safe, effective, patient-centered, timely, efficient, and equitable (Kovner, Brewer, Yingrengreung, & Fairchild, 2010). Healthcare professionals must be able to recognize the need for improvement, come up with an appropriate intervention, and evaluate the outcomes from trials (D’Eramo & Puckett, 2014). In a health care finance journal, an article was written about how quality care is being more focused on now because of the economic effects from poor quality care given is being consistent across U.S. hospitals (Andel, Davidow, Hollander, & Moreno, 2012). For example, in 2008 the IOM reported medical errors cost the U.S. $19.5 billion (Andel, Davidow, Hollander, & Moreno, 2012). This is important to consider when hospitals are being reimbursed a small percentage based on their adherence to clinical performance guidelines and the patient’s perception of the quality of care they have received (Gieger, 2012). The Joint Commission (TJC) is one of the regulatory agencies to emphasize quality improvement principles in a hospital setting (Cherry & Jacob, 2011). TJC has moved their motive from review of policies, facilities, and credentials to including process improvement, patient safety, and outcomes (Hall & Moore, 2008).

RNs’ have such a vital role in QI in patient safety and outcomes in hospitals because they are giving direct patient care. They can participate in professional improvement teams to form new care protocols and care pathways that may eventually be the new standard of care (Hall & Moore, 2008). This author works on a medical surgical floor that has similar teams but is called “patient improvement teams”. The team members on the patient improvement team include bedside nurses, PCAs, and support techs. Some of the teams are “patient satisfaction”, “fall prevention”, and “hospital acquire urinary tract infection prevention” team.