NURSES ROLE IN HOSPITAL QUALITY IMPROVEMENT - …

1 Online Journal ISSN : 2347 - 9671 www . April 2014 Vol - 2 Issue- 4. NURSES ROLE IN HOSPITAL QUALITY IMPROVEMENT . Adline*. *Nursing Superintendent, SLRTC HOSPITAL , Karigiri, Vellore, Tamil Nadu, India ABSTRACT. N urses today have many roles . In addition to meeting the needs of patients and serving as part of the health care team, NURSES also play a key role in meeting the Joint Commission's National Patient Safety Goals in such areas as medication safety, communication and patient safety. This role allows NURSES to contribute to QUALITY IMPROVEMENT . Continuous QUALITY IMPROVEMENT is a concept which includes: QUALITY assurance the provision of services that meet an appropriate standard. Problem resolution including all departments involved in the issue at hand. QUALITY IMPROVEMENT a continuous process involving all levels of the organization working together across departmental lines to produce better services for health care clients.

2 Deming and others have espoused total system reform to achieve QUALITY IMPROVEMENT not merely altering the current system, but radically changing it. It must be assumed that those who provide services at the staff level are acting in good faith and are not willfully failing to do what is correct. Those who perform direct services are in an excellent position to identify the need for change in service delivery processes. Based on this premise, the staff nurse . who is at the heart of the system is the best person to assess the status of health care services and to work toward improving the processes by which these services are provided to clients in the health care setting. The nurse manager must structure the work setting to facilitate the staff nurse 's ability to undertake constructive action for improving care.

3 KEY WORDS: HOSPITAL , health care, nurse managers, sustained IMPROVEMENT , QUALITY IMPROVEMENT , admin istrative burden, HOSPITAL leadership. April 2014 Vol - 2 Issue- 4 61. EPRA International Journal of Economic and Business Review ISSN : 2347 - 9671. INTRODUCTION activities. Hospitals with supportive The use of QUALITY circles, QUALITY leadership, a philosophy of QUALITY as councils, or QUALITY IMPROVEMENT forums to everyone's responsibility, individual facilitate the coordination of QUALITY accountability, physician and nurse IMPROVEMENT efforts is an effective way to champions, and effective feedback achieve success. The QA coordinator assists reportedly offer greater promise for departments in documenting that the successful staff engagement in IMPROVEMENT QUALITY IMPROVEMENT efforts are effective activities.

4 Across all departments of the organization, Yet hospitals confront challenges and aggregate data to demonstrate that they with regard to nursing involvement, meet the requirements of external regulatory including: scarcity of nursing resources;. agencies, insurers, and professional difficulty engaging NURSES at all levels . standards. The nurse executive provides the from bedside to management; growing vision and secures the necessary resources demands to par ticipate in more, often to ensure that the organization's QUALITY duplicative, QUALITY IMPROVEMENT activities;. IMPROVEMENT efforts are successful. By the burdensome nature of data collection inspiring and empowering the staff in their and reporting; and shortcomings of efforts to improve the process by which traditional nursing education in preparing health care is provided, nurse managers NURSES for their evolv ing role in today's participate in reshaping the health care contemporary HOSPITAL setting.

5 Because environment. The professional nurse plays NURSES are the key caregivers in hospitals, a vital role in the QUALITY IMPROVEMENT of they can significantly influence the QUALITY health care services. However, NURSES cannot of care provided and, ultimately, treatment make these improvements in a vacuum; they and patient out comes. Consequently, must include other professionals and hospitals' pursuit of high- QUALITY patient ancillary personnel in their efforts. Total care is dependent, at least in part, on their QUALITY commitment must include all levels ability to engage and use nursing resources of an organization's structure. QUALITY effectively, which will likely become more patient care services will be achieved as the challenging as these resources become result of positive interactions among increasingly limited.

6 Departments working together to build a QUALITY AS EVERYONE'S. dynamic mechanism that continuously RESPONSIBILITY. improves the processes and outcomes of A HOSPITAL culture that espouses health care services. QUALITY as everyone's responsibility is As the nation's hospitals face reportedly better positioned to achieve increasing demands to participate in a wide significant and sustained IMPROVEMENT . range of QUALITY IMPROVEMENT activities, the While hos pital respondents characterized role and influence of NURSES in these efforts the role of NURSES in QUALITY IMPROVEMENT is also increasing, according to a new study as crucially, they also emphasized that by the Center for Studying Health System nursing involvement alone is insufficient Change (HSC). HOSPITAL organiza tional because it is not simply nursing's work or cultures set the stage for QUALITY qual ity's work; it is the work of the whole IMPROVEMENT and NURSES ' roles in those organization.

7 April 2014 Vol - 2 Issue- 4 62. ISSN : 2347 - 9671 Adline In most hospitals, QUALITY improve ment While respondents acknowledged these are efforts transcend departments, and NURSES important factors, there was consider able are reportedly involved, at some level, in Across hospitals, broad-based staff virtually all of these activities because of inclusion in QUALITY IMPROVEMENT varies. their clinical expertise and responsibility for One HOSPITAL CNO reported, I wish qual ity the day-to-day coor dination of care and IMPROVEMENT could be done in a more other services for patients. However, multidisciplinary fashion. We tend to hand respondents said that to really improve off pieces to each other and work in silos. QUALITY , you have to have every staff NURSES themselves are very involved, but a member engaged, includ ing other clinical lot of what happens is beyond just the nurse .

8 Staff, such as physicians, pharmacists and I would like to be able to get the entire respiratory therapists, as well as nonclinical group, from NURSES to the pharmacy to lab staff, such as food ser vice, housekeeping techs to medical records to physicians and materials manage ment. As a director together in a multidisciplinary way to say, of QUALITY IMPROVEMENT stated, Nursing Something happened. Let's check what practice occurs in the context of a larger went wrong together.' To confront this silo team. Even on a pressure ulcers team, even mentality, one HOSPITAL moved the though it is primarily a nursing-focused report ing relationship of the QUALITY practice, you have the impact of nutrition, IMPROVEMENT department to the CEO as a for example. In cases that are clinically signal to staff that QUALITY IMPROVEMENT was challenging, like trans plants, you would not just a nursing activity but a also have the impact of our surgeons, for responsibility of all staff.

9 Instance.. LEADERSHIP SUPPORT. CULTURE SETS STAGE FOR QUALITY . To create a HOSPITAL culture IMPROVEMENT . supportive of QUALITY IMPROVEMENT , Across the board, respondents respondents stressed the importance of emphasized that a supportive HOSPITAL HOSPITAL leadership being in the vanguard culture is key to making important advances to engage NURSES and other staff. As a in QUALITY IMPROVEMENT . They identified representative of an accredit ing several key strategies that help foster QUALITY organization said, For any QUALITY improve ment, including: IMPROVEMENT project to be successful, the Supportive HOSPITAL leadership literature shows that support has to trickle actively engaged in the work; down from the top. That is important to Setting expectations for all staff not success.

10 That level of sponsorship has to be just NURSES that QUALITY is a shared there for QUALITY IMPROVEMENT to be respon sibility; suc cessful. Not only nursing leadership, but across the board from the CEO down.. Holding staff accountable for individual roles ; As an example, the CEO of one hos pital supported NURSES in their efforts to better Inspiring and using physicians and track and address the prevalence of bedsores NURSES to champion efforts; and among patients, even though doing so Providing ongoing, visible and useful required that the information be reported to feedback to engage staff effectively. a state agency. Despite the potential for April 2014 Vol - 2 Issue- 4 63. EPRA International Journal of Economic and Business Review ISSN : 2347 - 9671. negative attention to the HOSPITAL , the CEO SOME USEFUL FEEDBACKS.