Quality Improvement and Nurses

Quality Improvement

There are several key quality improvement activities in which my hospital participates. The first is the use of bedside shift reports. One of the reasons this improves quality is that it means that the nurse coming into a shift receives this report from the previous shift, and learns about the different things that happened. So there is more information that is being transferred between nurses, and that allows them to make better decisions, more accurate decisions and overall decisions that are better for the patient. This enhanced knowledge transfer has proven to be effective in a number of different studies.

Additionally, administrators measure outcomes, and relate those to the actions that people take. What this means is when a procedure has changed, the outcomes are measured and then evaluated against the past performance. If the new technique delivers better results, they keep it and if the new technique is not as effective then it can be removed from the operating procedure. Another quality improvement initiative is training that nurses receive on different things that are important to the job. This training helps with the constant process of improvement. A third thing that is done to help improve quality is that there are occasionally quality meetings among managers. Sometimes others are brought into these meetings. The objective is really just to identify where there are problems with quality, and to brainstorm different ways for how those things can be fixed or improvements implemented.

2. I do participate in some of these activities. I contribute to the bedside shift reports. I was in favor of this initiative and I have worked to make sure it is implemented smoothly. For me, this is important to make a positive contribution to communication in the hospital, especially in a way that delivers enhanced patient care.

I am able to make some contributions to things like meetings, and I take some of the training as well. But I also feel that I have a role where I have to vow to learn more for myself about quality. I need to take the time to understand what quality is, how it is measured and what sorts of things I can do to improve quality and the overall quality mindset at my hospital. I am not in a position where I can take a leadership role in quality -- there are things like level of authority that matter when actually trying to implement something. But to the extent that I am asked to be knowledgeable and to make a contribution, I make myself available for just that.

3. There are a few different factors that can affect a nurse's involvement in quality improvement. The first is the organizational structure at the hospital. There are different levels of empowerment that exist -- in some institutions nurses are handed more responsibility and therefore are also given more access to training and more responsibility with respect to quality initiatives. In other facilities, nurses are given less power and may not have much say in quality initiatives. So that is one reason. Another is that nurses are sometimes in a position where they are overworked, and do not have time to contribute to these sorts of things. This is not always the case, and but certainly there are situations where time is tight.

Then, there are just those organizations where there is not much commitment to quality improvement. In those situations, a nurse will have low involvement pretty much because the rest of the organization does as well. That happens sometimes -- and organizations with a high level of commitment to quality improvement are much more likely to engage all members of the organization in the process, often in different ways.

4. I feel that nurses are going to be more empowered going forward to make bigger contributions to quality improvement. There is definitely a role, and I have seen it already. Nurses have good ideas, and want to be able to contribute to quality improvement initiatives. When you work on the front line, you have a good perspective with respect to things that will help, things that will bring about improved quality and change.

Technology is another development that can affect the role of nurses in quality improvement. There are some things that technology makes easier -- and a bedside shift report is a good example. These reports are great because they represent a transfer of knowledge between nurses for the benefit of the patient. That transfer of knowledge is something that can occur electronically, making it easier to transfer more information more quickly, and this information can still be stored.