Discussion: Safety and Quality Improvement

Discussion: Safety and Quality Improvement

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Discussion: Patient Safety and Quality Improvement Act (PSQIA)

• Competency 4: Communicate in a manner that is consistent with expectations of a nursing professional.
  • Write coherently to support a central idea in appropriate format with correct grammar, usage, and mechanics.

To deepen your understanding, you are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of the business community.

• How do nurses develop best practice?
• How does research support best practice?
• What are best practices in your organization that you think are exemplars for improving patient care?
• What nursing roles should be in place to support the use of evidenced-based practice?
• How would you describe the concept of meaningful use and technology adoption stages: electronic health records (EHR) incentive programs, and how does this fit within the context of best practice?
• What are the main points to consider as you review The Health Insurance Portability and Accountability Act (HIPAA), and why is this best practice?
• How does the Patient Safety and Quality Improvement Act (PSQIA) support patient safety and improved patient outcomes?

• The necessity for quality and safety improvement initiatives permeates health care.^1, 2 Quality health care is defined as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”³ (p. 1161). According to the Institute of Medicine (IOM) report, To Err Is Human,⁴ the majority of medical errors result from faulty systems and processes, not individuals. Processes that are inefficient and variable, changing case mix of patients, health insurance, differences in provider education and experience, and numerous other factors contribute to the complexity of health care. With this in mind, the IOM also asserted that today’s health care industry functions at a lower level than it can and should, and it put forth the following six aims of health care: effective, safe, patient-centered, timely, efficient, and equitable.² The aims of effectiveness and safety are targeted through process-of-care measures, assessing whether providers of health care perform processes that have been demonstrated to achieve the desired aims and avoid those processes that are predisposed toward harm. The goals of measuring health care quality are to determine the effects of health care on desired outcomes and to assess the degree to which health care adheres to processes based on scientific evidence or agreed to by professional consensus and is consistent with patient preferences.

  Because errors are caused by system or process failures,⁵ it is important to adopt various process-improvement techniques to identify inefficiencies, ineffective care, and preventable errors to then influence changes associated with systems. Each of these techniques involves assessing performance and using findings to inform change. This chapter will discuss strategies and tools for quality improvement—including failure modes and effects analysis, Plan-Do-Study-Act, Six Sigma, Lean, and root-cause analysis—that have been used to improve the quality and safety of health care.

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  Measures and Benchmarks

  Efforts to improve quality need to be measured to demonstrate “whether improvement efforts (1) lead to change in the primary end point in the desired direction, (2) contribute to unintended results in different parts of the system, and (3) require additional efforts to bring a process back into acceptable ranges”⁶ (p. 735). The rationale for measuring quality improvement is the belief that good performance reflects good-quality practice, and that comparing performance among providers and organizations will encourage better performance. In the past few years, there has been a surge in measuring and reporting the performance of health care systems and processes.^1, 7–9 While public reporting of quality performance can be used to identify areas needing improvement and ascribe national, State, or other level of benchmarks,^10, 11 some providers have been sensitive to comparative performance data being published.¹² Another audience for public reporting, consumers, has had problems interpreting the data in reports and has consequently not used the reports to the extent hoped to make informed decisions for higher-quality care.^13–15

  The complexity of health care systems and delivery of services, the unpredictable nature of health care, and the occupational differentiation and interdependence among clinicians and systems^16–19 make measuring quality difficult. One of the challenges in using measures in health care is the attribution variability associated with high-level cognitive reasoning, discretionary decisionmaking, problem-solving, and experiential knowledge.^20–22 Another measurement challenge is whether a near miss could have resulted in harm or whether an adverse event was a rare aberration or likely

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