Overview and Summary: Healthcare and Quality: Perspectives from Nursing

  • Maureen Dailey, DNSc, RN, CWOCN
    Maureen Dailey, DNSc, RN, CWOCN

    Maureen Dailey DNSc, RN, CWOCN is a Senior Policy Advisor in Nursing Practice and Policy at the American Nurses Association. She has thirty years of nursing leadership, direct care, and quality improvement experience across healthcare settings. She has led the development, implementation, and evaluation of models and methods to improve care coordination and safety to reduce avoidable readmissions, healthcare associated conditions, and excessive cost across settings. Dr. Dailey has led programs to improve team-based care including interprofessional communication and collaboration and patient/caregiver engagement.  As the Director of the Centers for Excellence and Disease Management in the largest non-profit home health agency in the country, she implemented telehealth consultation; population risk stratification and management during prospective payment implementation; targeted transitional care for patients requiring complex care; and electronic health record innovations such as clinical decision support. In her current role, Dr. Dailey covers the National Quality Enterprise and has participated on multiple National Quality Forum-convened bodies, including the Critical Paths: Care Coordination Technical Expert Panel and the Readmissions Action Team. Dr. Dailey has been a member of the American Academy of Nursing's Care Coordination Task Force and is the co-chair of the ANA's Care Coordination Quality Measurement Professional Issues Panel.

Healthcare quality has been “front and center” in many newspaper, news television, and news magazine features. In healthcare professional literature, it is a rare journal that does not cite an Institute of Medicine (IOM) report from the Quality Chasm Series such as, To Err is Human or Crossing the Quality Chasm (IOM, 1999; IOM, 2001; IOM, 2003; IOM, 2010). As you might expect, the authors in this issue cite these multiple times. This is as it should be. In all other areas of commerce, consumers demand the highest quality they can afford in all of their products and services. In most other areas of commerce, quality is relatively easy to discern. The consumer can pick the product up, hold it to the light, and see its flaws or imperfections. For services, the consumer can ask her neighbor or search the Internet about whether the service was any good. The unusual part of healthcare is that the products and services are often so unique to the consumer that comparison seems impossible. The culture has evolved in such a way that it almost seems rude to ask.

Quality is a concept. It expresses people's perceptions of what makes something seem better or worse in some way that can only be measured by proxy, comparison, or using some abstract metric. Authors in this OJIN topic give their unique perspectives on quality, its measurement, and outcomes of quality research and application work starting with a broad overview of quality perspectives, followed by specific applications in research and clinical care, and ending with an overview of the National Quality Strategy that helps readers answer questions they may have about where nurses can fit in discussions about quality at various levels.

Before nurses can truly engage in quality policy and quality research, they must first learn about quality in context of their nursing roles. Dolansky and Moore explain the value of teaching and using systems thinking in quality. Their article, Quality and Safety Education for Nurses (QSEN): The Key is Systems Thinking, presents the QSEN educational initiative and its growth since its inception. QSEN gives a framework for applying the systems approach to healthcare quality. Using this systems approach, nurses can multiply their personal efforts and accelerate healthcare quality and safety improvements. The authors provide an overview of the QSEN competencies and educational programs that make this acceleration possible with examples of applications of the framework.

The next article, The Influence of Quality Improvement Efforts on Patient Outcomes And Nursing Work: A Perspective from Chief Nursing Officers at Three Large Health Systems, highlights this systems approach in practice by discussing quality projects in action. Authors, Weston and Roberts, contextualize three quality and performance improvement initiative vignettes with contributions from Chief Nursing Officers at the Department of Veterans Affairs, Kaiser Permanente, and Ascension Health. Each of the three systems has recently made significant investments into quality programs. The article describes how each system’s forward-thinking projects approached quality improvement from different, but equally valuable perspectives.

An Academic Practice Partnership: Helping New Registered Nurses to Advance Quality and Patient Safety takes the QSEN framework one step further. Flores, Hickenlooper, and Saxton provide an example of an academic-practice partnership that engaged undergraduate nursing students into the organizational level of quality improvement. Students worked with preceptors, faculty, and other organization staff at a large medical center to collect, analyze, and disseminate quality-related findings. The establishment of an academic-practice partnership allowed the organization to improve quality, while also giving students a much needed background in quality improvement.

In Building Linkages between Nursing Care and Improved Patient Outcomes: The Role of Health Information Technology, Dykes and Collins show the value of health IT and its ability to inform the development of quality policy through the use of electronically based quality measurement tools (eMeasures). The authors identify the promising applications of these measuring tools, but they do not shy away from the fact that these tools have inherent barriers. Nurses can use these tools to improve the quality of the care they provide, but have to recognize that the technology is limited by the current state of limited interoperability and the absence of content standards. The future state of healthcare quality measurement looks promising, particularly considering that federal regulations for quality-based incentive payments requires eMeasures. This is a promising area of nursing research and development.

The final article, An Overview of the National Quality Strategy: Where Do Nurses Fit? is a call to action for nurses at every level and position in the healthcare continuum to engage in the decision making process, particularly as it applies to healthcare quality. The article presents an overview of the opportunities nurses have to engage and methods of engagement. Kennedy, Murphy, and Roberts discuss the National Quality Strategy, federal advisory committees, and quality measurement data standards.

Reading the entire topic gives the reader an understanding of opportunities for engagement in the quality enterprise, an educational background in what to engage on, examples of student engagement, and examples of research and application of quality improvement activities. Readers will find considerable value in the pages that follow.

The journal editors invite you to share your response to this OJIN topic addressing Healthcare and Quality either by writing a Letter to the Editor or by submitting a manuscript which will further the discussion of this topic initiated by these introductory articles.

Maureen Dailey, DNSc, RN, CWOCN
Email: maureen.dailey@ana.org

© 2013 OJIN: The Online Journal of Issues in Nursing
Article published September 30, 2013


Institute of Medicine. (1999). To err is human: Building a safer health system. Retrieved from www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Retrieved from https://download.nap.edu/catalog.php?record_id=10027

Institute of Medicine. (2003). Health professions education: A bridge to quality . Retrieved from www.iom.edu/Reports/2003/Health-Professions-Education-A-Bridge-to-Quality.aspx

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Future%20of%20Nursing%202010%20Recommendations.pdf

Citation: Dailey, M., (September 30, 2013) "Overview and Summary: Healthcare and Quality: Perspectives from Nursing" OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 3, Overview & Summary.