U.S. News and World Report Best Hospitals, annual ranking: Available at http://health.usnews.com/best-hospitals
Public reporting of quality performance has been shown to improve care. While providers and policymakers do seek out these public quality reports, the general public does not search them out, does not understand them, distrusts them, and fails to make use of them (Marshall, Hiscock, & Sibbald, 2002). In many respects, hospitals are providing quality care. Data to assess clinical performance from the Joint Commission (JC) core measures program, which uses standardized, evidence‐based measures, and data from the Medicare program, show improvements in the quality of care in hospitals (Williams et al., 2005).
Disease Management
According to the The Care Continiuum Alliance (2010), disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self‐care is significant. What makes caring for patients with chronic diseases problematic is that the patients usually have multiple chronic conditions (e.g., the patient with congestive heart failure who also has hypertension, diabetes, emphysema, urinary incontinence, and chronic pain). Heart disease, stroke, cancer, chronic respiratory diseases, and diabetes are the leading cause of mortality in the world (WHO, 2019). Common, modifiable risk factors underlie the major NCDs. They include tobacco, harmful use of alcohol, unhealthy diet, insufficient physical activity, overweight/obesity, raised blood pressure, raised blood sugar, and raised cholesterol (WHO, 2019).
Evidence From the Literature
Source: Adapted from Yong, P., Saunders, R., & Olsen, L. (2010). Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary [National Institutes of Health]. doi: http://www.nap.edu/catalog/12750.html
Discussion: The IOM's Roundtable on Value & Science‐Driven Health Care has been convened to help transform the way evidence on clinical effectiveness is generated and used to improve health and health care. Participants have set a goal that, by the year 2020, 90% of clinical decisions will be supported by accurate, timely, and up‐to‐date clinical information, and will reflect the best available evidence.
This summary highlights the presentations and discussions from these workshops, delving into the major causes of excess spending, waste, and inefficiency in health care. The ideas and observations presented are offered in the truism that health reform, now and in the future, will benefit from identifying actionable options to lower health care costs in ways that maximize value.
Implications for Practice: This series delves into the major causes of excess spending, waste, and inefficiency in health care. By understanding where waste exists, nurses can help reduce waste and improve patient and cost outcomes.
Balanced Scorecards
Another type of results reporting that is used by organizations is the balanced scorecard. A balanced scorecard is a framework to implement and manage strategy. It links a vision to strategic objectives, measures, targets, and initiatives. It balances financial measures with performance measures and objectives related to all other parts of the organization. They are used to monitor customer perspective; financial perspective; internal processes and human resources; and learning and growth for strategic management and as a way to examine performance throughout the organization. This examination allows the organization to review multiple key areas of performance, selected on the basis of their importance to the organization's strategic plan for quality.
Evidence‐Based Practice
The body of evidence supporting clinical practice is steadily growing. However, even when evidence‐based quality care guidelines are available for numerous conditions, for example, diabetes, congestive heart failure, and asthma, they have not been fully implemented in actual patient care, and variation in clinical practice is abundant (IOM, 2001; McGlynn et al., 2003; Timmermans & Mauck, 2005). Health care knowledge continues to expand. This requires practice guidelines and the measures of quality on which they are based to be continually updated. It also requires attention to continuing to develop health care quality.
Accreditation and Patient Safety
Health care accreditation is a mechanism used to ensure that organizations meet certain national standards. Hospitals and other organizations seek accreditation to demonstrate their abilities to meet national quality standards. The Joint Commission (JC), formerly known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), is the preeminent regulatory body overseeing health care quality. Its review processes are extensive, and payments to a hospital by government insurers of health care (CMS) are dependent on the organization's ability to meet JC standards with a high degree of compliance (Table 2.10). In addition, other federal, state, local, and voluntary regulatory agencies oversee the quality of specific organizational components such as pharmacy, laboratory, long‐term care, rehabilitative care, dietary, behavioral health, and fire safety. Accreditation, which signifies that the organization meets the standards for practice of these oversight agencies, influences market perception about the quality of health care that the organization provides and engenders trust and confidence in the organization.
Table 2.10 Hospital Accreditation Standards Overview
| Environment of careEmergency managementHuman resourcesInfection prevention and controlInformation managementLeadership | Life safetyMedication managementMedical staffNational patient safety goalsNursingProvision of care, treatment, and services | Performance improvementRecord of care, treatment, and servicesRights and responsibilities of the individualTransplant safetyWaived testing |
Source: © Joint Commission: CAMH: 2010 Comprehensive Accreditation Manual for Hospitals. Oakbrook Terrace, IL: Joint Commission, 2011, available at www.jcrinc.com/Joint-Commission-Requirements/Hospitals
Critical Thinking 2.3
Review the case studies on reducing harm to patients at, www.commonwealthfund.org/Innovations/Case-Studies.aspx
What can each staff member do to improve the quality of care, especially the safety of patient care?
How can we work toward a culture of continual improvement for those issues and situations that cause errors and almost lead to errors?
How much control do nurses have in identifying errors and reporting them?
What can you do to improve the quality of care afforded in your organization?
Improving Quality Through Health Professions Education
There is a need to focus on retooling the health care workforce with new knowledge and requisite skills to function in better, redesigned health care systems. To begin to realize the quality agenda set forth by the IOM (2001), a subsequent report, Health Professions Education: A Bridge to Quality (IOM, 2003c), delineates a needed overhaul of the curriculum of health professionals' education to transform current skills and knowledge (IOM, 2003c, p. 1). This curriculum includes training clinicians to develop:
1 Ability to provide patient‐centered care: Patient‐centered care emphasizes recognition of the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for the patient's preferences, values, and needs. It builds knowledge of effective communication approaches that allows patient access to information and