Finkelman, Leadership and Management for Nurses: Core Competencies for Quality
Care, 3rd edition.
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Chapter 18: Implementing Healthcare Quality Improvement
LEARNING OUTCOMES AND SUGGESTED CLASSROOM AND CLINICAL
ACTIVITIES
LEARNING OUTCOME 1
• Describe the science of improvement and implications for healthcare quality and
culture of safety.
Suggestions and Strategies for the Classroom Experience
• Ask students to describe the science of improvement and its implications in a
team discussion.
• Explore the ISRN website in the classroom with the students.
LEARNING OUTCOME 2
Discuss examples of critical healthcare quality issues.
Suggestions and Strategies for the Classroom Experience
• Discuss the difference in Blame Culture and Culture of Safety. Ask students how
they feel about this topic.
LEARNING OUTCOME 3
Examine workplace safety as a critical aspect of quality improvement.
Suggestions and Strategies for the Classroom Experience
• In class go online and review the OSHA and NIOSH websites for current
Suggestions and Strategies for the Clinical Experience
• In clinical ask students to identify workplace safety concerns and strategies used
in the workplace to prevent or resolve the workplace safety concern.
LEARNING OUTCOME 4
Compare two methods used to measure and improve care and their relationship to
structure, process, or outcomes.
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Suggestions and Strategies for the Classroom Experience
• Student teams should work together to compare two measurement methods and
summarize their work in a 2–3-page document that is then posted in course
Suggestions and Strategies for the Clinical Experience
• Ask a nurse who is involved in continuous quality improvement in a local HCO to
talk to the class about how the HCO measures structure, process, and outcomes to
ensure quality care.
LEARNING OUTCOME 5
Describe Joint Commission accreditation and its relevance to quality improvement.
Suggestions and Strategies for the Classroom Experience
• Go to the Joint Commission website in class and review content.
Suggestions and Strategies for the Clinical Experience
LEARNING OUTCOME 6
Describe the role of nurses in continuous quality improvement and nursing initiatives to
improve care.
Suggestions and Strategies for the Classroom Experience
• Discuss why it is important for nurses to participate in QI. Ask a nurse to discuss
the roles.
Suggestions and Strategies for the Clinical Experience
LEARNING OUTCOME 7
Discuss the need for interprofessional quality improvement initiatives.
Suggestions and Strategies for the Classroom Experience
• Discuss why there has been movement to interdisciplinary QI. Ask students how
this relates to the IOM five core competencies.
Suggestions and Strategies for the Clinical Experience
• What type of interprofessional QI is the HCO doing? Have a staff member
describe.
LEARNING OUTCOME 8
Examine the role of nursing leadership in quality improvement and need for changes to
improve nursing leadership.
Suggestions and Strategies for the Classroom Experience
Suggestions and Strategies for the Clinical Experience
KEY CHAPTER CONCEPTS
1. The Science of Improvement focuses on three questions: (1) What are we trying to
accomplish? (2) How will we know that a change is an improvement? (3) What changes
can we make that will result in improvement?
3. Traditionally, healthcare organizations have handled errors using the punitive Blame
Culture approach, asking “Who is at fault?” rather than “Why did our defenses fail?”
4. There is a movement to change to a Culture of Safety, which recognizes that it is often
5. Factors related to analyzing errors, organization and management, work environment,
team, individual staff member, task, and patient.
7. Workplace safety is part of CQI. Examples of concerns are; Ergonomics, needle sticks,
violence in the workplace, latex allergies, chemical exposure, and infections.
8. As healthcare providers and organizations have become more experience in assessing
quality, they have turned more to performance-based quality care evaluations, with the
critical assessment question being “Did the patient benefit from the care received? If so,
how? If not, why?” Key terms are; Measure, threshold, safety, error, and adverse events
9. There are many methods to measure and ensure quality, safe care. Some examples are
standards of care, credentialing, utilization review/management, clinical guidelines,
10. Examples of measurement metrics: (1) Policies and procedures: application of
process metric; serious reportable events (see Table 18-1); (2) Standards of care:
application of process metric; (3) Licensure, credentialing, and certification: application
11. Accreditation is the process by which organizations are evaluated on their quality,
based on established minimum standards. The process does not ensure quality of care.
12. Healthcare organizations voluntarily request accreditation every three years; however,
13. With an emphasis on continuous quality improvement, the Joint Commission requires
15. Changes in accreditation focus: more experience in assessing quality; more
performance-based; and did the patient benefit from the care received? If so, how? If not,
why?
16. There is greater need for collaborative quality improvement with nurses involved (see
Figure 18-1).
18. CQI includes evaluation of programs in addition to evaluation of individual patient
care.
19. The ANA developed a quality report card based on ten nursing-sensitive indicators
for use in community-based non-acute care settings. They are pain management,
cardiovascular disease prevention, consistency of communication, caregiver activity, staff
AF Draft 05/24/15
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20. Leadership, communication, and knowledge are all essential qualities a nurse must
have to implement effective quality improvement. There are many different roles that
APPLYING LEADERSHIP AND MANAGEMENT
BSN and Master’s Essentials: Application to Content
Chapter identifies which Essentials apply to the chapter content. This information is
primarily for the instructor, but students should understand the how these nursing
education standards apply to the chapter content and the nursing profession.
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
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
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:
As nurse manager for a large orthopedic unit, you are reviewing quality improvement
data as well as data from human resources regarding workplace safety. The hospital is
making an effort to reduce staff workplace injuries, and you need to consider this as you
see a trend on the unit that you do not like. You begin by learning more about the
problem and then consider actions.
Questions:
1. What are the typical nursing staff workplace safety concerns? (ANA website has
information, as does OSHA and NIOSH.)
2. What data do you need to track?
3. After you identify the three most common workplace safety concerns, you develop
strategies to reduce them. What do you plan to do?
4. How can you get the staff involved in an initiative to reduce workplace safety
concerns?