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Finkelman, Leadership and Management for Nurses: Core Competencies for Quality Care,
3rd edition.
1
Chapter 17: Healthcare Quality: A Critical Health Policy Issue
LEARNING OUTCOMES AND SUGGESTED CLASSROOM AND CLINICAL
ACTIVITIES
LEARNING OUTCOME 1
Examine the content and implications of the Institute of Medicine and its healthcare quality and
nursing reports.
Suggestions and Strategies for Classroom Experience
• Divide the students into teams and ask each team to take one core competency and
discuss what it means to them; have them prepare a summary statement to share.
Suggestions and Strategies for Clinical Experience
• Ask each student to apply the five core competencies to their assigned patient.
LEARNING OUTCOME 2
Examine the current status of healthcare quality.
Suggestions and Strategies for Classroom Experience
• Discuss influences on quality. Ask students to identify examples in news media and
discuss.
Suggestions and Strategies for Clinical Experience
• Ask students to identify influences on quality that pertain to assigned patients and discuss
in post-conference.
LEARNING OUTCOME 3
Discuss the relevance of legislation and governmental and nongovernmental initiatives and
strategies to improve healthcare quality policy.
Suggestions and Strategies for Classroom Experience
• Ask students to search for more information on legislation, governmental initiatives, or
LEARNING OUTCOME 4
Critique critical issues related to defining quality health care, including measurement, structure,
process and outcome elements.
Suggestions and Strategies for Classroom Experience
• Ask each student to write her own definition of quality care. Compare with chapter
content.
Suggestions and Strategies for Clinical Experience
• In clinical conference discuss measures that might be used to monitor quality for the unit
in which the students are assigned.
LEARNING OUTCOME 5
Explain the National Quality Strategy and its relationship to other content in this chapter.
Suggestions and Strategies for Classroom Experience
Suggestions and Strategies for Clinical Experience
KEY CHAPTER CONCEPTS
1. The fourth IOM core competency is to apply quality improvement by identifying errors and
3. Sparked by President Clinton’s creation of the Presidential Advisory Commission on
4. In 1999, the IOM published To Err Is Human, a report that showed the magnitude of harm
5. The 2001 IOM report Crossing the Quality Chasm focuses on the need to develop a new
healthcare system that can keep up with today’s rapidly changing world (see Figure 17-1).
6. The IOM created a set of rules for the 21st century to guide care delivery and improve
healthcare system. They were care based on continuous healing relationships; customization
Finkelman, Leadership and Management for Nurses: Core Competencies for Quality Care,
3rd edition.
3
7. Envisioning National Health Care Quality established the need for an annual national report
8. In 2003, the IOM identified 20 priority areas for quality improvement. The first two were to
promote care coordination and self-management/health literacy. The other areas were concerned
10. Health Professions Education identifies five core competencies that all healthcare
professionals must have in order to improve quality care.
11. Public health has become more important in a world affected by globalization, rapid travel,
scientific and technological advances, and demographic changes. The IOM developed report on
public health: Who Will Keep the Public Healthy? This focuses on preparation for healthcare
13. The Future of Nursing. Leading Change, Advancing Health is the second major IOM report
14. There are a number of governmental indicators indicating increased interest in quality
improvement such as legislation (Patient Safety and Quality Improvement Act of 2005 and ACA
15. There are a number of nongovernmental indicators indicating increased interest in quality
16. Quality is a complex concept, with many factors affecting it. The three accepted elements of
quality that serve as the framework for the assessment of care are structure, process, and
17. Medicare is invested in improving health care, for example establishment of QIOs and
implementation of HACs (see Table 17-1).
19. High reliability organizations are more prevalent in HCOs (see Figure 17-5).
20. The National Quality Strategy is an important new initiative (see Figures 17-6, 17-7, 17-8,
and Table 17-2).
APPLYING LEADERSHIP AND MANAGEMENT
BSN and Master’s Essentials: Application to Content
1. Increased legislation is one indication that shows a public concern for care. In 2005, the
2. Another indication of interest in health care quality focuses on the purchasers of care in the
private sector.
My Hospital Unit: An Evolving Case Experience
See the overview of the My Hospital Unit feature found in the front of the textbook. Refer
students to the specific My Hospital Unit scenario found in the chapter.
This chapter feature can be used in a variety of ways within a course. Students can be asked to
Applying AONE Competencies
The AONE competencies for nurse leaders are found in Appendix A. Ask students to identify
which of the AONE competencies apply to the content in the chapter.
Engaging in the Content: Critical Thinking and Clinical Reasoning and Judgment
See Discussion Questions and Application Exercises at the end of the chapter. Online options are
noted.
Chapter Features: Case Study and Applying Evidence-Based Practice
The Chapter Features: Case Study and Applying Evidence-Based Practice features may be used
in both classroom and online formats. The last two slides in the PPT slides include the questions
ADDITIONAL CASE
This case is not found in the textbook. It may be used for individual or team assignments: written
assignment and classroom or online team discussions. It may also be used as an essay question
for exams.
Case:
The county public health department administrator is a nurse. He is meeting with his colleagues
at a statewide public health meeting. The county directors are concerned about improving public
health throughout the state. One of the directors comments that they should look at the new
National Quality Strategy. This leads to a discussion.
Questions:
1. What is the National Quality Strategy (NQS)?
2. Why is it relevant for a local public health program to consider the NQS in its planning?
3. How could the NQS be applied to a statewide initiative?
