Healthcare and Quality: Perspectives from Nursing
October 11, 2018
Response by Stefani Magnowski to “The Influence of Quality Improvement Efforts on Patient Outcomes and Nursing Work: A Perspective from Chief Nursing Officers at Three Large Health Systems” by Marla Weston and Darryl W. Roberts (September 30, 2018)
This letter is in response to the article, "The Influence of Quality Improvement Efforts on Patient Outcomes and Nursing Work: A Perspective from Chief Nursing Officers at Three Large Health Systems." The theme of the article surfaced as only focusing on the adoption of technology and data in the clinical setting as quality improvement (QI) initiatives to impact outcomes and nursing work. While I strongly agree that adopting the use of technology and data can positively affect those factors, there is however, a component to patient outcomes and nursing workflows influenced by QI efforts that is missing from this article, which is process improvement.
Focusing only on systems that impact the structure in providing care, such as the adoption of technology, is only half of the solution. Nurses must also recognize and be concerned with process improvement, which helps to reduce waste by creating standardized and structured approaches in delivering care. Process improvement drives value-added care by streamlining existing processes within nursing workflows to be more patient-centered, timely, efficient, equitable, and effective (Institute for Healthcare Improvement, 2017). Thus, to optimally impact patient outcomes and nursing workflows, both structure and processes must be evaluated and improved upon.
Patient outcomes rely on consistent healthcare structure and processes to provide value. By changing the process of how inpatient child and adolescent psychiatric nurses provided care to their patients in an inpatient psychiatric hospital, we reduced the total restraint events from 487 to 270 over one-year. The following year, restraints were further reduced from 270 to 42! This result occurred by optimizing the existing structure and standardizing care delivery processes to improve patient outcomes (Donabedian, 1988). As the article highlighted, data has an important place in QI efforts. Use of data was instrumental in the restraint reduction efforts, as it was used as a driver for change in the process and secured buy-in from nursing and other frontline staff.
Stefani Magnowski, MSN, RN, CNE, NE-BC
Manager of Quality
Donabedian, A. (1988). The quality of care: How can it be assessed? JAMA, 260(12), 1743-1748.
Institute for Healthcare Improvement. (2017). Across the chasm: Six aims for changing the healthcare system. Retrieved from http://www.ihi.org/resources/Pages/ImprovementStories/AcrosstheChasmSixAimsforChangingtheHealthCareSystem.aspx
Weston, M., & Roberts, D. (2013). The influence of quality improvement efforts on patient outcomes and nursing work: A perspective from Chief Nursing Officers at three large health systems. OJIN: The Online Journal of Issues in Nursing, 18(3). doi:10.3912/OJIN.Vol18No03Man02