Containing costs while promoting quality care can be complex. Rise to the challenge! By Leslie R, Smith, MSN, RN
NURSE EXECUTIVES ARE TASKED WITH ENSURING A PRECISE BALANCE BETWEEN PROMOTING SAFE, QUALITY CARE FOR PATIENTS AND PURSUING A POSITIVE BOTTOM LINE. WE MUST WEATHER THE NURSING SHORTAGE AND AVOID COSTLY EXPENDITURES, SUCH AS UTILIZING AGENCY STAFF AND APPROVING OVERTIME FOR REGULAR STAFF. INTERDISCIPLINARY PRACTICE, SAFE WORK PRACTICES, AND ANNUAL MANDATORY COMPETENCIES ARE ALL AREAS IN WHICH WE CAN PROMOTE PATIENT SAFETY. IT’S ALSO THE NURSE EXECUTIVE’S ROLE TO ENGAGE IN TEAM-BUILDING ACTIVITIES AND TASKFORCES TO DRIVE CHANGE THAT WILL IMPROVE PERFORMANCE AND CREATE A CULTURE OF SAFETY. A group of researchers in Quebec was tasked with promoting effective operations by reorganizing care and work to improve quality, retention, and reduction in costs.1 The researchers teamed with key leadership to share the vision, mission, and values of the organization and identify the purpose and needs of the staff members. They found that it was vital to investigate the organizational structure, culture, leadership style, and environment before promoting change. They also note that for organizational change to occur, leaders must encourage participation, mobilization, and innovation by team members.1 Nurse executives can utilize these strategies to promote change that will lead to a culture of safety. The importance of a culture of safety
The Institute of Medicine (IOM) has authored several publications that focus on improving quality and safety in healthcare. The 1999 report, To Err is Human, estimated that close to 90,000 annual deaths in the United States are preventable and caused secondary to errors in the healthcare delivery process.2 This publication led healthcare leaders to make changes to improve the care given to patients. In a second report, Crossing the Quality Chasm, the IOM discussed the complex intricacies of the healthcare system and the need to improve care, focusing on six pillars: (1) safety, (2) patient-centered, (3) effectiveness, (4) timeliness, (5) efficiency, and (6) equity.3 Ensuring that care focuses on the six pillars promotes improved quality in a safe environment. Growing the culture of safety has led healthcare leaders to put systems in place to reduce the chance of errors. Such systems are part of the integration of health information or, more specifically, chronic disease management systems (CDMSs) and the electronic medical record (EMR). One group of researchers presented a case study that reviewed health information technology (HIT) for its ability to potentially improve the overall efficiency and quality of care.4 They examined the implementation and use of an EMR and CDMS at one facility, seeking to understand how these systems are used to facilitate and enhance patient care and provider satisfaction. They found that HIT is slow to be implemented, but it’s important to improve quality care and patient safety. Implementing CDMS and EMRs will standardize and promote best practices, ultimately reducing errors and saving time. Implications of pay for performance
Nurse executives provide the link between the executive team and the working staff. We’re an integral part of achieving the organization’s mission and promoting the organization’s values, growth, and fiscal performance related to quality initiatives.5 The Premier Hospital Quality Incentive Demonstration (HQID) is a program in which the Centers for Medicare and Medicaid Services (CMS) “aims to see a significant improvement in the quality of inpatient care by awarding bonus payments to hospitals for high quality in several clinical areas, and by reporting extensive quality data on the CMS web site.”6 At the onset of this project, many healthcare leaders doubted the efficacy of the initiatives. One research study scrutinized the outcomes of hospitals participating in the HQID versus those...