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chapter 10 | Quality and Safety 137 CikguOnline
■ Assists benchmarking and performance Structured Care Methodologies
monitoring
Most agencies have tools for tracking outcomes.
■ Stimulates change and becomes the building block
These tools are called structured care methodologies
for the next plan (planware.org/strategy.htm)
(SCMs). SCMs are interdisciplinary tools to “iden-
During the strategic planning process, the organi- tify best practices, facilitate standardization of care,
zation develops or reviews its vision, mission state- and provide a mechanism for variance tracking,
ment, and corporate values. A group develops quality enhancement, outcomes measurement, and
business objectives and key strategies to meet these outcomes research” (Cole & Houston, 1999, p. 53).
objectives. In order to do this, a SWOT analysis is SCMs include guidelines, protocols, algorithms,
done—a review of the organization’s Strengths, standards of care, critical pathways, and order sets.
Weaknesses, Opportunities, and Threats. Key
■ Guidelines. Guidelines first appeared in the
strategies are identified, and action plans are devel-
1980s as statements to assist health-care
oped. The organization’s mission, goals, and strate-
providers and patients in making appropriate
gic plan ultimately drive the outcomes and QI plan
health-care decisions. Guidelines are based on
for that organization. Be proactive, and participate
current research strategies and are often devel-
in the process. Ask your nurse manager if there are
oped by experts in the field.The use of guidelines
opportunities for the staff to participate in the
is seen as a way to decrease variations in practice.
planning process.
■ Protocols. Protocols are specific, formal docu-
Issues related to QI may also come out of the
ments that outline how a procedure or interven-
strategic planning process. Quality issues are not
tion should be conducted. Protocols have been
often apparent to senior managers. Staff members
used for many years in research and specialty
at the unit level can often identify quality issues
areas but have been introduced into general
because they are the ones who can feel the impact
health care as a way to standardize approaches
when quality is lacking. Once a process that needs
to achieve desired outcomes. An example in
improvement is identified, an interdisciplinary
many facilities is a chest pain protocol.
team is organized whose members have knowledge
■ Algorithms. Algorithms are systematic proce-
of the identified process. The team members meet
dures that follow a logical progression based on
to identify and analyze problems, discuss solutions,
additional information or patient responses to
and evaluate changes. The team clarifies the cur-
treatment. They were originally developed in
rent knowledge of the process; it identifies causes
mathematics and are frequently seen in
for variations in the process and works to unify the
emergency medical services. Advanced cardiac
process. Box 10-6 identifies questions that team
life support algorithms are now widely used in
members might ask as they work on the QI plan.
health-care agencies.
■ Standards of care. Standards of care are often
discipline-related and help to operationalize
box 10-6 patient care processes and provide a baseline for
Questions the Team Needs to Ask quality care. Lawyers often refer to a discipline’s
standards of care in evaluating whether a patient
1. Who are our customers, stakeholders, markets?
2. What do they expect from us? has received appropriate services.
3. What are we trying to accomplish? ■ Critical (or clinical) pathways. A critical path-
4. What changes do we think will make an improvement? way outlines the expected course of treatment
5. How and when will we pilot-test our predicted for patients with similar diagnoses. The critical
improvement?
6. What do we expect to learn from the pilot test? pathway should orient the nurse easily to the
7. What will we do with negative results? positive results? patient outcomes for the day. In some institu-
8. How will we implement the change? tions, nursing diagnoses with specific time
9. How will we measure success? frames are incorporated into the critical path-
10. What did we learn as a team from this experience? way, which describes the course of events that
11. What changes would we make for the future?
lead to successful patient outcome within the
Adapted from McLaughlin, C., & Kaluzny, A. (2006). Continuous Quality
diagnosis-related group (DRG)–defined time
Improvement in Health Care: Theory, Implementations, and Applications.
3rd ed. Massachusetts: Jones & Bartlett. frame. For the patient with an uncomplicated