Online Companion: Fundamentals of Nursing Standards and Practice 2E

Chapter Summary

When clients and providers consider the health care delivery system, three themes emerge: the need for high quality health care, care provided at reasonable cost, and the ability for citizens to access the available health services. In Chapter 25, the historical and current efforts to improve and maintain quality of care in health care are closely examined. How quality is defined and measured are questions that challenge the health care system. The major accrediting organization in health care, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) identifies nine indicators of quality performance: efficacy, appropriateness, availability, timeliness, effectiveness, continuity, safety, efficiency and respect. The American Nurses' Association in its Standards of Clinical Nursing Practice suggest using three domains to measure quality: structure, process and outcome. The quality improvement movement has grown in health care because of consumer demands for high quality care at reasonable cost. Health care organizations need to improve quality in order to maintain financial viability and to meet regulatory requirements for accreditation and reimbursement. There has been improvement in quality improvement techniques which have been shown to enhance performance and work processes. There are legal considerations that impact on quality management; health care organizations must comply with federal regulations, such as OSHA requirements, Food and Drug Administration (FDA) codes. Health care organizations see the quality improvement program as a protection against substandard care and potential lawsuits. In summary of the first section of Chapter 25, quality improvement is a good thing for the health care system.

One approach to quality management is continuous quality improvement (CQI) in which everyone is involved in examining ways to improve the entire organization. The health care organization shifts to a customer perspective in a quality improvement program. The organization solicits customer feedback about their services and has a program to deal with customer complaints. The organization itself impacts on quality management in these ways: its organizational culture, the diversity of its work forces, the degree of staff empowerment, the effectiveness of its leadership, and the teamwork dynamic. It is now recognized that quality improvement must focus on the systems within an organization and shift from trying to improve individual performance to establishing new and stable processes that build-in quality performance. The tools commonly used to collect data about organizational performance are these: audit, benchmarking, peer review, and clinical pathways. The nurse working in the organization functions in roles of clinician, manager and team member. There are responsibilities for quality improvement unique to each of these roles. For instance, in the clinician role, the manages time efficiently and works to achieve customer satisfaction.