Health care organizations increasingly rely on quality improvement, or QI, to deliver more value for less money. Quality improvement involves more than making updates to processes and procedures. It is a codified and structured approach to improvement organizations can use to set goals related to health care quality, patient satisfaction, process enhancement, and more. Hallmarks of quality improvement include systemic enhancement, data analysis, quantifiable interventions, and performance measurement. Whether QI adoption is driven by internal demand or external forces, the professionals who provide or oversee patient care services are often the most qualified to identify what is and is not working in health care environments.
Nurses play a pivotal role in QI implementation for several reasons. They make up the largest segment of U.S. health care providers, representing 30% of hospital employees and a sizable segment of the workforce in other areas of health care. Nurses also spend significantly more time with patients compared to other providers. RNs and nurse managers have a thorough understanding of the resources necessary to care for patients effectively and efficiently. And their frontline nursing care experience makes them uniquely suited to lead initiatives focused on clinical transformation, patient safety, and patient satisfaction.
Continuous quality improvement initiatives may be more successful when nurse leaders who possess advanced education in quality science, decision science, performance analytics, and resource allocation step up to drive change. The University of Michigan School of Nursing’s Online MSN in Leadership, Analytics, and Innovation program can help you become one of them. It teaches experienced clinical nurses with BSNs to use data to facilitate continuous quality improvement in their organizations and change nursing for the better.
Defining Quality Improvement in Health Care
This systematic, data-driven approach to enhancing patient care and patient safety in health care environments addresses six primary areas of patient care outlined by the National Academy of Medicine: efficiency, effectiveness, equity, respect, safety, and timeliness.
Efficiency focuses on quality improvements to reduce unnecessary waste and provider burnout as much as possible without compromising the patient experience or patient satisfaction.
Effectiveness refers to the fact that all change must result in measurable improvements to patient safety and outcomes, process efficiency, resource allocation, or provider wellbeing.
Equity involves improving access to care and quality of care for all. Biases should not exist in health care based on gender, socioeconomic status, ethnicity, or other factors. Inclusivity among staff is vital as hospitals and health facilities need nurses with diverse cultural, ethnic, and religious backgrounds to effectively care for diverse populations.
Respect is crucial because person-centered care is a critical component of QI. Clinical decisions in primary care and other settings must align with patient needs.
Safety is emphasized in the framework because all improvements must enhance providers’ ability to give patients the best possible care. Upgrading care processes and systems cannot lead to mistakes.
Timeliness is important because process delays invite risk in medical settings. QI initiatives should reduce roadblocks and make it easier for providers to deliver value.
The six core pillars help nurse leaders and other clinicians identify broad and granular areas of improvement in nursing practice, create actionable solutions for driving change, develop measurable goals, identify metrics for measurement, and analyze initiative impact. They act as a flexible guide to QI, which is dynamic. Nurses must approach quality improvement programs with the understanding that there is always room for incremental change.
Why Continuous Quality Improvement Is Important
Quality improvement is an ongoing process that challenges the status quo, not a one-and-done initiative. QI-focused health systems integrate sustained transformation into daily operations by setting goals, establishing a culture of quality improvement, building QI infrastructure, putting methods into practice, measuring improvements, and adjusting strategy as necessary to meet evolving benchmarks. Applying the QI framework is incremental, progressive, and iterative because as initial goals are met, new goals emerge.
Fundamentally, QI is as simple as making, measuring, and adjusting improvements, and then repeating the process. Most organizations find, however, that a deeper dive is necessary to reap the benefits of quality improvement initiatives. Continuous QI looks at organizational and patient outcomes and addresses managerial and clinical processes required to improve those outcomes. It works particularly well in health care environments because the cyclical nature of the work presents never-ending opportunities to optimize, evaluate, and improve.
The perpetual nature of continuous QI can be a stumbling block. Maintaining the necessary focus on performance improvements can be challenging in the long term — particularly in chaotic and stressful medical settings. When everyone works at their capacity, handling the day’s duties takes precedence over maintaining quality measures in the long term. The continuous quality improvement framework focuses on processes instead of the work of individuals so people are less likely to become overwhelmed.
Nurse leaders need to lead the charge in QI implementation. They are equipped to show RNs that while viewing one’s nursing practice through a QI lens can be overwhelming at first, the benefits of continuous quality improvement make the necessary time and resource investment worthwhile. Implementing the framework can reduce redundancy, waste, costs, and risk and improve operational efficiency and clinical outcomes. Additionally, a demonstrable commitment to nursing quality shines a positive light on an organization, leading to increases in strategic partnerships and funding opportunities.
Examples of Quality Improvement Initiatives in Health Care
Showing quality improvement in nursing examples or examples of QI in other areas of health care can be difficult because improvements should be specific to an organization. For instance, a hospital might design a plan to reduce postoperative readmissions by changing the discharge process. A medical practice might explore measurable ways to improve the accuracy of medication lists as part of QI initiatives focused on reducing medical errors. A nurse manager who is aware that Electronic Health Records (EHR) systems can increase mental demand on nurses might focus on process enhancements specific to that system.
Health care leaders across departments must look to their organizations first for guidance when developing quality assurance and improvement initiatives. Only then can they address specific issues that need attention. Many organizations find significant room for improvement in processes related to care coordination, electronic medical record documentation, medication administration, patient engagement, patient safety, readmission rates, staff engagement, and infection control.
Nurses, doctors, administrators, and leaders in health care organizations can do several things to identify potential areas of improvement. First, they can research case studies to learn more about how thriving health care systems implement and maintain QI in different clinical and administrative departments. Next, they can look for pain points — areas where processes break down or with quantifiable room for improvement. Finally, they can establish preliminary goals, formulate a theory of change, define quality indicators, and put a plan into action.
Some health care organizations take QI a step further and assemble dedicated improvement teams made up of clinicians and administrators responsible for developing goals, promoting quality assurance initiatives, and monitoring signs of progress.
The Role of Nurses in Quality Improvement
Even before quality improvement became codified as a framework, it was a part of nursing. Nurses at all levels — from bedside nurses to Chief Nursing Officers — have long recognized how challenging it is to provide high-quality patient care in an imperfect system. A study by the Center for Studying Health System Change (HSC) found that nurses are integral to official and unofficial QI efforts because “they spend the most time at the patient’s bedside and are in the best position to affect the care patients receive during a hospital stay” and are “the eyes and ears of the hospital.”
Bedside nurses are particularly well-placed to positively influence the patient experience as well as patient outcomes. Their buy-in is increasingly essential as facilities and networks face increasing demands to launch QI programs as part of Value-Based Care (VBC). According to the American Nurses Association, the staff nurse 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.”
However, staff nurses are not the only nurses critical to QI success. Nurse managers change health care environments for the better by inspiring and empowering staff in their quest to improve processes. Nurse executives help drive organizations’ QI strategies and help secure the resources necessary to ensure continuous quality improvement efforts are successful.
It is essential to have nurses at all levels participate in QI projects even when other stakeholders lead because frontline nurse participation expedites transformation. Quality improvement is built into nursing — not as an extra duty busy nurses have to take on in addition to their primary responsibilities but as part of existing processes. As one hospital CEO who participated in the HSC study put it: “when nurses champion a project, they are able to achieve ‘real, sustained improvement.’”
Nurses Face QI Challenges
Involving nurses and nurse leaders in collaborative quality improvement projects is crucial to success, yet nurses tackling improvement work run into significant roadblocks. For example, capacity issues can get in the way of QI success. RNs who are overworked or work in understaffed departments may have to choose between acting as caregivers and fully engaging with process improvement initiatives. They may feel pushed into either/or situations instead of taking a “yes, but” approach to both when they are overworked.
Additionally, bedside nurses may not feel they have a voice in QI projects. In contrast, nurse managers may feel obligated to participate in as many quality improvement initiatives as possible — to the detriment of other activities. Nurses at all levels may disengage when they do not understand their role in QI. And asking nurses to handle additional data collection, analysis, and reporting tasks can be a burden in settings with technology that is out of date or hard to use.
Finally, traditional clinical nursing education models do not adequately prepare nurses to participate in systematic quality improvement. Considering the emphasis of QI in today’s health care system, however, quality improvement should be a part of nursing education at the bachelor’s degree and master’s degree levels. One participant in the HSC study linked above indicated that nurses in academic programs should learn about change models and be taught the basics of the QI framework. They added that, “data are all around nurses, and they are using data for clinical decisions. We need them to understand how to use data to change practice.”
The widespread adoption of continuous QI may represent an opportunity for qualified nurses to take the lead in redesigning the quality of care for the betterment of patients — and the nursing profession — provided they have the requisite skills. U-M School of Nursing’s Online MSN program covers the applications of analytics in decision analysis, program and process evaluation, quality science, and the foundations of change management in health care because understanding QI is good for nurses.
One study that tracked clinical nurses put in charge of QI teams discovered that participating nurses reported feeling highly satisfied with not only the improvements they’d brought about but also the new skills they acquired in the process and the overall impact of their work. Feeling impactful at work is a win-win situation for clinicians, the health organization, and of course, the patient. Ultimately, research suggests that involving nurses in quality improvement can expand nurses’ influence at all levels and make health care better.
To learn more about who pursues the MSN and why, the wide range of career pathways for MSN holders, the online student experience at U-M, or financial aid options, register for an upcoming online event. Or take the next step in your nursing career and apply online today.
What is quality improvement in nursing care? ›
Quality improvement is the framework used to systematically improve care. Quality improvement seeks to standardize processes and structure to reduce variation, achieve predictable results, and improve outcomes for patients, healthcare systems, and organizations.What is quality improvement example? ›
Examples of Quality Improvement Projects in Reducing Unnecessary Medical Procedures that Can Increase Patient Risks and Medical Costs. Restricting blood transfusions to only patients who unquestionably need them results in better outcomes for all patients.How can nurses contribute to quality improvement? ›
Nurses are directly involved in almost all aspects of hospital quality, including patient care, bedside and medication management, assistance with surgeries and other major operations, data collection/reporting, and more.What are the quality improvement activities? ›
A QI program is a set of focused activities designed to monitor, analyze, and improve the quality of processes in order to improve the healthcare outcomes in an organization. By gathering and analyzing data in key areas, a hospital can effectively implement change.What are 3 areas of improvement nursing? ›
Three themes in the areas for improvement — confidence, knowledge, and communication — were in the top 10 for most of the jobs we studied. Yet the top themes for work improvement appeared to be more job specific, compared to those themes provided for the strengths.What are the 3 types of measures for quality improvement? ›
Three Types of Measures
Use a balanced set of measures for all improvement efforts: outcomes measures, process measures, and balancing measures.
- Integrity. Integrity involves being honest and upholding strong ethics and morals. ...
- Initiative. Initiative refers to a person's ability to take action without goading. ...
- Ambition. ...
- Time management. ...
- Leadership. ...
- Delegation. ...
- Communication. ...
- Teamwork and collaboration.
Quality improvement tools are standalone strategies or processes that can help you better understand, analyze, or communicate your QI efforts. Examples of QI tools include run charts, process maps, and fishbone diagrams (ihi.org).What are four main principles of quality improvement? ›
In addition to focusing on the patient-centered dimension of care, quality improvement efforts also focus on safety, effectiveness, efficiency, and timeliness.What are my weaknesses as a nurse? ›
Reflect on your weaknesses
Spending too much time on paperwork. Paying too much attention to detail. Attempting to complete too many tasks at once. A lack of clinical experience, which may apply to recent graduates or new nurses.
Why is quality improvement in healthcare important? ›
Quality improvement can lead to increased patient safety, more effective and efficient care, and improved patient outcomes. It can also help to reduce the cost of health care. Quality improvement is a continuous process that should be a part of every health care organization.What are 3 examples of weaknesses? ›
- Lack of knowledge of particular software.
- Public speaking.
- Taking criticism.
- Lack of experience.
- Inability to delegate.
- Lack of confidence.
- Limit distractions. This is a tip many people know but rarely follow: limit your potential distractions. ...
- Set milestones. ...
- Set clear and achievable goals. ...
- Avoid multitasking. ...
- Improve your time management. ...
- Do important tasks first. ...
- Delegate tasks whenever possible. ...
- Clear your workspace.
What's your biggest weakness? Advice: Be cautious but honest and let them know how you're trying to improve. Don't answer this question with a cop out answer such as “I'm a bit of a perfectionist.” Example Answer: I am uncomfortable with confrontation.What are the five key measurements of quality improvement? ›
- The problem,
- The goal,
- The aim,
- The measures, and.
- The Analytics.
Examples include: Number of beds and the types of services available. Whether the hospital is accredited or has other types of specialty certification. The use of electronic patient medical records or prescription ordering systems.What is quality improvement plan? ›
A quality improvement plan is a basic guidance document that describes how a health department will. manage, deploy, and review quality. It also serves to inform staff and stakeholders of the direction, timeline, activities, and importance of quality and quality improvement.ii. Purpose.What are 5 areas of improvement? ›
What are areas of improvement? Areas of improvement are skills, qualities or abilities that an employee could develop or enhance. Areas of improvement could include time management, delegation, organization, communication and engagement. Many of these skills and abilities are those that employees use daily at work.What should I write for areas of improvement on a performance review? ›
- Could try to help and support team members more for the success of the project.
- Other members of the team feel they could behave in more approachable manner.
- Should work on developing and maintaining professional relationships.
- Fails to encourage a team-centered work environment.
- Have a positive attitude. ...
- Take criticism well. ...
- Practice self-motivation. ...
- Learn from your mistakes. ...
- Develop strong communication skills. ...
- Don't be afraid to ask questions. ...
- Be adaptable. ...
- Be an effective teammate.
What are the 5 key performance indicators in healthcare? ›
Five key performance indicators for healthcare organizations: People, quality, time, growth & financial performance.What are the four quality indicators? ›
Quality Indicator Modules
The AHRQ QIs include four modules: Prevention Quality Indicators (PQIs), Inpatient Quality Indicators (IQIs), Patient Safety Indicators (PSIs), and Pediatric Quality Indicators (PDIs).
The Quality Director is basically the coach, facilitator, and mentor. His or her job is to instill principles of quality at all levels, helping everyone in the organization — every employee, executive, service user, caregiver, and consultant— feel driven to achieve excellence.What are the 7 quality control tools explain? ›
Histogram: The most commonly used graph for showing frequency distributions, or how often each different value in a set of data occurs. Pareto chart: A bar graph that shows which factors are more significant. Scatter diagram: Graphs pairs of numerical data, one variable on each axis, to look for a relationship.What are quality techniques? ›
Quality techniques include all tools, procedures and methods that are used in the field of quality management and quality assurance at all product creation levels to solve specific problems.How could I improve at work? ›
- Set the right expectations.
- Have milestones and goals.
- Organize, plan and prioritize.
- Avoid distractions.
- Do one thing at a time.
- Don't leave things unfinished.
- Read something new everyday.
- Communicate effectively.
- Reduce Medical Errors and Improve Patient Safety. ...
- Offer Telehealth and Other Technologies. ...
- Manage Chronic Diseases. ...
- Ensure Continuity of Care and Discharge Procedures. ...
- Communicate with Patients and Educate Them About Their Health. ...
- Analyze Data.
That IOM report committee recommended six aims for improvement: health care should be safe, effective, patient-centered, timely, efficient, and equitable. In this paper, we focus specifically on two of those aims: health care that is patient-centered and equitable.What are the 6 dimensions of quality improvement? ›
Discussion Questions: Don Berwick describes six dimensions of quality in health care: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.How can a nurse improve performance at work? ›
- Dress for Success. You have probably heard the adage “dress for success” plenty of times throughout your career. ...
- Be People-Oriented Not Task-Oriented. ...
- Establish Goals. ...
- Make Communication a Priority. ...
- Take Care of Yourself. ...
- Never Stop Learning.
What is your greatest strength in nursing? ›
Having empathy to interact with the patient and their family and helping them to cope with problems is very important in a nursing position. Having the ability to understand and share those feelings with the patient and their loved ones is an essential strength for a nurse.How do you deal with a difficult patient interview question? ›
DEALING WITH PATIENTS Interview Questions & Answers ... - YouTubeWhat is the goal of nurses quality improvement efforts? ›
The goal is to deliver safe, high-quality health care to patients in all clinical settings. You can use the information in this guide to help improve quality of care across settings and at multiple levels.What is quality improvement NHS? ›
Quality improvement is the continual actions to improve outcomes for service users and to develop the workforce that supports them using systematic methods. The two key elements are 'continual' and 'systematic'. There are many accepted care improvement methods, such as Lean, PDSA (Plan, Do, Study, Act), and Six Sigma.What are the key elements of a quality improvement initiative? ›
All successful quality improvement programs include four key components: the problem, goal, aim, and measures. All successful quality improvement programs start with an in-depth understanding of the problem.What are quality improvement tools? ›
Quality improvement tools are standalone strategies or processes that can help you better understand, analyze, or communicate your QI efforts. Examples of QI tools include run charts, process maps, and fishbone diagrams (ihi.org).What is the first step in the quality improvement process nursing? ›
- Step 1: People.
- Step 2: Problem.
- Step 3: Aim.
- Step 4: Measures.
- Step 5: Change ideas.
- Step 6: Tests of change.
- Step 7: Spread. Now you have cracked the formula think about who else could benefit from your wisdom. Who might be facing a similar problem? Share your learning and knowledge.
Quality improvement is focused on making processes better. The first step is finding your practice's key problems. You then need to identify and prioritize potential change projects.Why is quality improvement important NHS? ›
While driving better value is important, quality improvement has a fundamental role in improving all aspects of quality – including the safety, effectiveness and experience of care. All health and care systems should be seeking to improve these aspects of care for people using their services, on a continuous basis.What quality improvement means? ›
Quality improvement is about giving the people closest to issues affecting care quality the time, permission, skills and resources they need to solve them. It involves a systematic and coordinated approach to solving a problem using specific methods and tools with the aim of bringing about a measurable improvement.
What is the main goal of quality improvement? ›
What Is the Main Purpose of Quality Improvement? Quality improvement aims to create efficiencies and address the needs of customers. In healthcare, the main purpose of quality improvement is to improve outcomes.What are the five key measurements of quality improvement? ›
- The problem,
- The goal,
- The aim,
- The measures, and.
- The Analytics.
That IOM report committee recommended six aims for improvement: health care should be safe, effective, patient-centered, timely, efficient, and equitable. In this paper, we focus specifically on two of those aims: health care that is patient-centered and equitable.What are four main principles of quality improvement? ›
In addition to focusing on the patient-centered dimension of care, quality improvement efforts also focus on safety, effectiveness, efficiency, and timeliness.What are the 7 quality control tools explain? ›
Histogram: The most commonly used graph for showing frequency distributions, or how often each different value in a set of data occurs. Pareto chart: A bar graph that shows which factors are more significant. Scatter diagram: Graphs pairs of numerical data, one variable on each axis, to look for a relationship.What is quality improvement plan? ›
A quality improvement plan is a basic guidance document that describes how a health department will. manage, deploy, and review quality. It also serves to inform staff and stakeholders of the direction, timeline, activities, and importance of quality and quality improvement.ii. Purpose.