Classification of Nursing Practice: www.icn.ch
Note that setting standards for appropriate care and guideline development should have a basis in validated measures of quality, using reliable performance data, and making appropriate adjustments in care delivery. Reliable methods and measures need to be developed and tested. Some practitioners have been resistant to their care delivery being measured because they have believed that it would interfere with their professionalism and autonomy. If this belief persists, the majority of health care delivery will not be measured.
Malcolm Baldridge National Quality Award
Health care organizations are eligible to consider another framework for health care quality and to apply for the Malcolm Baldridge National Quality Award. The Health Care Criteria of the Malcolm Baldridge National Quality Award explores a hospitals mission and key objectives in seven critical areas: Leadership, Strategy, Customers, Measurements, Workforce, Operations, and Results. The Baldrige framework is based on core values and concepts that represent beliefs and behaviors found in high‐performing organizations. Baldrige works with public and private sector partners to address critical national needs related to long‐term success and sustainability, including cybersecurity risk management and excellence in US communities (Eastman, 2019).
Outcome Measurement
Outcome measurements can be done indicating an individual's clinical state, such as the severity of illness, course of illness, and the effect of interventions on the individual's clinical state. Outcome measures involving a patient's functional status evaluate a patient's ability to perform activities of daily living (ADLs). These can include measures of physical health in terms of function, mental and social health, cost of care, health care access, and general health perceptions. The measures can distinguish the concepts of physical and mental health and identify the five indicator categories of clinical status, functioning, physical symptoms, emotional status, and patient/family evaluation, and in Canada perceptions about quality of life. Selected quality‐of‐life measures include quality‐adjusted life years (QALYs), quality‐adjusted life expectancy (QALE), and quality‐adjusted healthy life years (QUALYs) (Drummond, Stoddart, & Torrance, 1994).
Other Health Assessment Tools
The assessment of health‐related quality of life (HR‐QOL) is an essential element of health care evaluation. Many generic and specific HR‐QOL instruments have been developed and include the Medical Outcomes Study 36‐Item Short Form (SF‐36) health survey; the Nottingham Health Profile (NHP); the Sickness Impact Profile (SIP); the Dartmouth Primary Care Cooperative Information Project (COOP) Charts; the Quality of Well‐Being (QWB) Scale; the Health Utilities Index (HUI); and the EuroQol Instrument (EQ‐5D) (Coons, Rao, Keininger, & Hays, 2000). The U.S. News & World Report (2019) reports that the country with the best quality of life is Canada, followed by Sweden and Denmark. The U.S. lags in sixth place.
Public Reporting of Performance
Public reporting of organizational performance and quality information is being driven by several forces. As more data about quality become available electronically, individuals reporting the data and those wanting to make comparisons among organizations want the data analyzed and the findings reported. This information can be used to determine where there are health care inefficiencies and poor quality of care. Performance reporting is also used to influence clinician and patient utilization behavior. It also moves health care toward a population‐based approach, as opposed to focusing on individual patient care.
Institute of Medicine Health Care Reports
The IOM, established in 1970 under the charter of the National Academy of Sciences, provides independent, objective, evidence‐based advice to policymakers, health professionals, the private sector, and the public. In 1996, the IOM launched a concerted, ongoing effort focused on assessing and improving the nation's quality of care. The Ensuring Quality Cancer Care Report (1999) documented the wide gulf that exists between ideal cancer care and the reality many Americans with cancer experience.
Other reports released by the IOM on the quality of health care include:
To Err is Human; Building A Safer Health System (1999);
Crossing the Quality Chasm: A New Health System for the Twenty‐first Century (2001);
Strategies for Addressing the Evolving Nursing Crisis (2002);
Patient Safety: Achieving a New Standard for Care (2003);
Keeping Patients Safe: Transforming the Work Environment of Nurses (2003);
Health Professions Education: A Bridge to Quality (2003);
Priority Areas for National Action: Transforming Health Care Quality (2003);
Performance Measurement: Accelerating Improvement (2005);
Preventing Medication Errors (2006); and
The Future of Nursing: Leading Change, Advancing Health (2010).
A complete listing of IOM Reports is available at www.iom.edu/Reports.aspx
Eight principles are integral to health care reform, as envisioned by the IOM (2008). These eight principles are:
Accountability
Efficiency
Objectivity
Scientific rigor
Consistency
Feasibility
Responsiveness
Transparency
These principles are consistent with a professional nursing agenda, which states that all persons are entitled to affordable, quality health care services (American Nurses Association (ANA), 2010). The Quality Chasm report described broader quality issues, defined six aims, and highlighted ten rules for care delivery redesign (Table 2.7) (IOM, 2001).
Other National Public Quality Reports
Several key national public quality sources of interest for health care and nursing leaders and managers for purposes of performance measurement and benchmarking or comparison are as follows:
AHRQ National Healthcare Quality Report 2009 Available at www.ahrq.gov/qual/nhqr09/nhqr09.htm
AHRQ National Healthcare Disparities Report 2009 Available at www.ahrq.gov/qual/qrdr09.htm
Healthy People 2010: Available at www.healthypeople.gov
Health Grades for Hospitals and Physicians: Available at healthgrades.com
Leapfrog: Available at www.leapfroggroup.org
The National Quality Forum: Available at www.qualityforum.org
Health Plan and Employer Data and Information Set (HEDIS) & Quality Measurement, National Committee for Quality Assurance (NCQA): Available at www.ncqa.org
Consumer Assessment of Healthcare Providers and Systems (CAHPS), Agency for Healthcare Research and Quality (AHRQ): Available at www.cahps.ahrq.gov/default.asp
Medicare Hospital Compare: Available at www.hospitalcompare.hhs.gov.
The Thomson Reuters 100 Top Hospitals ®: