Discussion: 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 Discussion: Quality and Safety 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). Discussion: Quality and Safety

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: Discussion: Quality and Safety

• 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 the Walden Library databases. When nurse leaders have strong critical thinking skills, it creates a better work environment for others. This article examines that influence and its impact on patient safety and delivering quality care. Current Nursing. (2011). Nursing theories: A companion to nursing theories and models: From novice to expert. Retrieved from http://currentnursing.com/nursing_theory/Patricia_Benner_From_Novice_to_Expert.html This website outlines the Novice to Expert Theory, applied to nursing, by Patricia Benner. Kaminski, J. (2010). Theory applied to informatics—Novice to expert. Canadian Journal of Nursing Informatics, 5(4). Retrieved from http://cjni.net/journal/?p=967 Kaminski explains the Novice to Expert Theory and its application in nursing practice. Marchigiano, G., Eduljee, N., & Harvey, K. (2011). Developing critical thinking skills rom clinical assignments: A pilot study on nursing students’ self-reported perceptions. Journal of Nursing Management, 19(1), 143-152. doi:10.1111/j.1365-2834.2010.01191.x. Note: You will access this article from the Walden Library databases. NSW Health. (2011). Discussion: Quality and Safety

Benner’s stages of clinical competence. Retrieved from http://www.health.nsw.gov.au/nursing/projects/Documents/novice-expert-benner.pdf Walden University. (2012j). Walden University writing center: Critical reading. Retrieved from http://writingcenter.waldenu.edu/454.htm As you evaluate research articles, or information found on the Internet it is important to read the material with a critical eye. The Walden Writing Center offers many excellent resources and strategies for reading critically. Walden University Writing Center. (2010). What is critical thinking? Retrieved from http://writingcenter.waldenu.edu/Documents/Scholarly-Writing/Critical_Thinking_(Final).pdf The Walden Writing Center provides a succinct overview of critical thinking and critical reading. This brief article provides a definition of critical thinking and its characteristics. Critical Thinking Recall your early clinical nursing experiences—what guided your decisions? Did you practice nursing ‘by the book’? Now, consider how you make decisions today. How have your clinical experiences fostered a greater depth of knowledge and critical thinking? This week’s Learning Resources explore skill development and levels of knowledge acquisition based on clinical experience. For example, Benner suggests that as a nurse gains more experience, knowledge and skill level increases. Nurses move from novices—making decisions based on rules—to experts who are able to see connections between actions and outcomes using critical thinking. This Discussion focuses on the role of critical thinking in nursing practice and the connection between critical thinking, clinical competence, and scholarship. To prepare: • Review the Learning Resources focusing on critical thinking and Benner’s interpretation of the Novice to Expert theory. • Reflect on how critical thinking is used in clinical practice. How does critical thinking relate to, or support, clinical competence? • What critical thinking strategies do you use to improve your clinical competence and thus move from novice to expert? • Consider the connection between critical thinking, nursing practice, and scholarship. Write your observations on how critical thinking is used in clinical practice (provide examples); how you employ critical thinking strategies to improve clinical competence; and your thoughts on the connections between critical thinking, scholarship, and practice. Support your Discussion assignment with specific resources used in its preparation using APA formatting. You are asked to provide a reference for all resources, including those in the Learning Resources for this course. .. Discussion: Quality and Safety