A Summary of the October 2009 Forum on the Future of Nursing Acute Care (2010) / Chapter Skim
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3 Quality and Safety
3 Quality and Safety
Pages 15-24
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From page 15... ...
• Efficiency: Even as hospital costs continue to rise at rates higher than inflation, evidence shows that hospitals with particularly high costs do not necessarily provide higher quality care. Waste is present in most hospitals.
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From page 16... ...
For example, the Commonwealth Fund Commission on a HighPerformance Health System has supported the development of a state scorecard on health system performance that has made it possible to translate best practices and knowledge across the system. On a set of hospital clinical quality indicators, the rates in the five lowest performing states approached the previous levels of the highest performing states (McCarthy et al., 2009)
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From page 17... ...
For example, when a flood in Cedar Rapids forced 300 patients to be evacuated from the hospital within 3 hours, many off-duty nurses arrived to move sandbags and transport those patients to other hospitals as far as 200 miles away. Bisognano offered six priorities for the committee to consider.
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From page 18... ...
Bisognano said she has seen nurses walk off the unit at the end of the day exhausted from working in poorly designed workflow processes, and with out the skills they need to make the changes on the front line. She also has seen nurses who feel fulfilled and vital, and who are respected at the end of a long and hard shift because work proc esses have been designed to support their professional skills.
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From page 19... ...
As a simple example of work that is not value added, Minnier cited fall risk assessments. At UPMC, the fall screening admission assessment had grown to 24 sections on paper and 30 sections as an electronic record.
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From page 20... ...
It includes tasks such as admission assessments, medication distribution, assistance with activities of daily living, turning, risk assessment, wandering assessment, comfort rounds, and environmental checks. Unreliable, or unpredictable, work occurs randomly over the course of 24 hours and includes activities such as preparing or transferring a patient for testing or procedures, answering call bells, family communication, placing a patient in isolation, and emergencies.
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From page 21... ...
Dr. Kurt Swartout, chief of Hospital Medicine at Kaiser Permanente Roseville Medical Center, pointed out that quality measures are often
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From page 22... ...
"We [need to] design systems such that the continuing care that happens in the hospital, with nurses and teams, continues after discharge." Finally, Nancy Chiang, former secretary/treasurer of the California Student Nurses Association, noted that student nurses often believe they do not get to spend enough time with nurses in a clinical setting learning their profession.
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From page 23... ...
The IHI recently brought together representatives of 10 institutions that had low costs and high-quality outcomes at a meeting entitled "How Do They Do That? " These models of excellence need to become visible, she said, so that as health care reform progresses, any hospital can adapt proven practices to local circumstances.
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From page 24... ...
unaligned incentives, lack of knowledge, or lack of understanding." National programs such as Transforming Care at the Bedside can elevate issues to a level beyond the institution and lead to meaningful change. Also, one step the IHI has taken is a program to build the skills of physicians, nurses, students, administrators, and others to fix broken processes on the front line.
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