ArticleStrategies to advance health care quality
Section snippets
Looking at quality through the clinicians' eyes
There are many stakeholders involved in the provision of quality care—patients, providers, purchasers, payers, policy makers, and researchers—each of whom may have a slightly different view about quality. The definition of quality care illustrates these variations. Researchers, policy makers and accrediting bodies typically define quality care as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with
Moving beyond physician care as a synonym for quality care
Quality care is more than care delivered by physicians. To date, however, there is a strong tendency to assess quality based on the profession of medicine. It is possible that the word “medicine” is used generically to encompass all health care disciplines. However, indicators suggest quality care is currently conceptualized using a physician focus which leads to impressions of problems that are only partially correct. Moreover, the powerful potential in calls for collaboration and
Expanding the triple typology used to classify quality problems
Health care quality problems are frequently classified using a triple typology related to overuse, underuse, and misuse.1, 2, 6, 20, 21 These terms generally refer to the “dose” of care as being too much (eg, prescribing antibiotics when they are not warranted), too little (eg, not prescribing beta-blockers when they are warranted), or incorrect (eg, errors in diagnosis and/or treatment) respectively. This typology focuses on treatments and the technical aspects of care.
If the purpose of the
Enriching the evidence base for quality care
Proponents of the quality movement correctly call for using knowledge as the foundation for practice as well as the basis for establishing sound environments of care. It is therefore disappointing to realize that scientific evidence has had only a modest impact on molding care delivery practices.2, 4 It is also disappointing to realize there are gaps in evidence that “…undermine efforts to improve the scientific basis of health care decisions…”.44 These gaps derive from a variety of sources
Nursing leadership for quality: a call to action
Nurses are recognized as the backbone of the health industry50 and the glue that holds hospitals together.51 Nevertheless, nurses and nursing remain conspicuously absent from influential quality initiatives. As a first step in changing this situation, nurses need to decide whether, as a profession, we want to seriously engage in the work of improving health care quality in America. If the answer is no, then we need to accept the status quo and cease voicing our concerns. If the answer is yes,
Conclusion
Bold strategies are needed to initiate the sweeping changes necessary to radically reform the quality of care in America. These strategies will meet with only modest success unless the conceptualizations underpinning current quality initiatives are identified and changed. Clinicians' views about quality need to become more dominant because their actions determine whether quality is really improving. The physician-oriented assessments of quality need to be replaced by genuine collaborative
Acknowledgements
The authors are grateful to several reviewers, both known and unknown, whose thoughtful critiques helped improve this paper. However, the opinions and ideas expressed in this paper are strictly the views of the authors.
Bonnie Mowinski Jennings is a Senior Nurse Scientist, Geneva Foundation and Health Care Consultant at Alexandria, VA.
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Bonnie Mowinski Jennings is a Senior Nurse Scientist, Geneva Foundation and Health Care Consultant at Alexandria, VA.
Margaret L. McClure is President of the American Academy of Nursing and a Professor at New York University, New York, NY, USA.