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Hospitals with outstanding nursing quality share 4 key traits


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Rebecca Hendren, for HealthLeaders Media, February 1st, 2011

“Think globally, act locally” is a familiar idiom from the green movement, and it’s appropriate to apply when considering quality improvement initiatives at your healthcare organization.

Quality indicator dashboards for organizations are valuable benchmarking tools, but the interesting data analysis happens when you drill down to the unit level. You might discover that one unit has had fewer catheter-associated urinary tract infections than another unit with a similar patient population. Then it becomes a question of replicating success.

The American Nurses Association’s National Database of Nursing Quality Indicators (NDNQI) collects nursing-related performance data from more than 1,700 hospitals at the unit-level. The data allow organizations to compare themselves to other nursing units either in their region or on the other side of the country. They can use the results to set benchmarks on various aspects of nursing care, patient outcomes, patient safety, and nurse satisfaction.

Last month, nurses and quality improvement professionals met in Miami for the fifth annual NDNQI conference to discuss best practices for improvement.

“It’s a step forward for healthcare and good for our patients whenever we can bring so many nursing experts together to share how they have used data to improve their performance,” said American Nurses Association President Karen Daley. “Transforming healthcare requires making evidence-based decisions that promote delivery of quality care and put the patient at its center. That’s what NDNQI and this conference are all about.”

Five organizations were recognized at the conference for extraordinary nursing quality:

  • University of Kansas Hospital, Kansas City, KS – academic medical Center
  • Medical Center of the Rockies, Loveland, CO – community hospital
  • Poudre Valley Hospital, Fort Collins, CO – teaching hospital
  • Children’s Hospital & Medical Center, Omaha, NE – pediatric hospital
  • Craig Hospital, Englewood, CO – rehabilitation hospital

“The NDNQI Award recognizes a hospital’s ability to identify areas for improvement in its nursing performance and to design and implement effective strategies to achieve better patient outcomes,” said Daley. “The common traits of the award-winning hospitals are strong leadership, teamwork, commitment to ongoing improvement in patient care quality, continuous staff education, and efficient use of resources.”

Hospitals that have demonstrated excellent outcomes in nursing-sensitive quality measures—such as pressure ulcers, falls, and catheter-associated urinary tract infections—share similar traits. They have identified systematic processes for quality improvement that involve staff in the identification and measurement.

1. Nurses must be actively involved. Each unit has different patient populations and different quality challenges and the most effective performance improvement arises organically from that culture. Nurses on each unit must be actively involved in collecting data, completing chart reviews, benchmarking results, and sharing results.

2. Quality outcomes should be visible. Top performing organizations communicate openly and frequently about quality data.

Many display unit-specific data right on the unit so that staff nurses can clearly see how their unit is doing and how it compares to others. This keeps staff engaged and allows for swift reaction. For example, if data shows a sudden increase in patient falls, the unit can immediately identify the problem and start a course correction.

Plus, don’t underestimate the value of unit pride. Having a “better than national benchmark” score on various quality indicators is a source of great satisfaction and can be a powerful motivator if those scores change.

3. Support evidence-based practice. Organizations with excellent nursing quality benchmarks actively ensure the latest research is implemented into practice. Many organizations employ clinical nurse leaders or doctorally prepared nurse researchers to help staff identify clinical issues and utilize research.

4. Promote autonomy and accountability. Nursing-sensitive quality indicators are so called because they are to do with the structure, process, and outcomes of nursing care. Top organizations expect nurses to be responsible for these indicators and hold them accountable to the measures. They empower them with the autonomy to decide how nursing care is provided and how improvements should be conducted.