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chapter 10 | Quality and Safety 135 CikguOnline
strategy and action plans to redesign the health-care box 10-5
system.The report stated that the gaps between actu-
Six Aims for Improving Quality in
al care and high-quality care could be attributed to Health-Care (IOM, 2001, p. 39).
four key inter-related areas in the health-care system:
Health care should be:
the growing complexity of science and technology,an
1. Safe: Avoiding injuries to patients from the care that is
increase in chronic conditions, a poorly organized intended to help them
delivery system of care, and constraints on exploiting 2. Effective: Providing services based on scientific
the revolution in information technology. With the knowledge to all who could benefit and refraining from
overarching goal of improving the health-care system providing services to those not likely to benefit
(avoiding underuse and overuse)
by closing identifiable gaps, the report made 13 rec-
3. Patient-centered: Providing care that is respectful of
ommendations, some of which are in Box 10-4. and responsive to individual patient preferences, needs,
Additionally, the report addressed the importance of and values and ensuring that patient values guide all
aligning and designing health-care payer systems, clinical decisions
professional education, and the health-care environ- 4. Timely: Reducing waits and sometimes harmful delays
for those who receive and those who give care
ment for quality enhancements, improved outcomes
5. Efficient: Avoiding waste, in particular that of
in care, and use of best practices. equipment, supplies, ideas, and energy
As a professional nurse, you have a responsibility 6. Equitable: Providing care that does not vary in quality
to acknowledge the complexity and deficits of the because of characteristics such as gender, ethnicity,
health-care system. In managing patient care, you geographic location, and socioeconomic status
must continually consider the impact of the system
on the care you provide and participate in the qual-
ity and safety initiatives at the bedside, in your unit, QI
and within your organization to promote quality QI activities have been part of nursing care since
and safety within the system. Florence Nightingale evaluated the care of soldiers
during the Crimean War (Nightingale & Barnum,
Quality in the Health-Care System 1992). To achieve quality health care, QI activities
use evidence-based methods for gathering data and
The IOM defines quality as “the degree to which achieving desired results.
health services for individuals and populations QI usually involves common characteristics
increase the likelihood of desired health outcomes (McLaughlin & Caluzny, 2006, p 3):
and are consistent with current and professional
■ A link to key elements of the organization’s
knowledge” (IOM, 2001, p. 232). This definition is
strategic plan
used by U.S. organizations and many international
■ A quality council consisting of the institution’s
health-care organizations, and it is the basis for
top leadership
nursing management of patient care.Box 10-5 elab-
■ Training programs for all levels of personnel
orates on this definition by outlining six primary
■ Mechanisms for selecting improvement oppor-
aims of health care.
tunities
■ Formation of process improvement teams
■ Staff support for process analysis and redesign
box 10-4
■ Personnel policies that motivate and support
Ten Rules to Govern Health-Care Reform
for the 21st Century (IOM, 2001, p. 61) staff participation in process improvement
• Care is based on a continuous healing relationship QI is called by many names: quality assurance,
• Care is provided based on patient needs and values FADE, PDSA, total quality management (TQM),
• Patient is source of control of care Six Sigma,and CQI.Regardless of the term used,QI
• Knowledge is shared and free-flowing
• Decisions are evidence-based is a structured organizational process for involving
• Safety as a system property personnel in planning and executing a continuous
• Transparency is necessary; secrecy is harmful flow of improvements to provide quality health care
• Anticipate patient needs that meets or exceeds expectations (McLaughlin &
• Waste is continually decreased Kaluzny, 2006, p. 3). The following sections focus
• Cooperation between health-care providers
on CQI.