Kelly Vana's Nursing Leadership and Management

Achieving health care transparencyor truth in reporting is the ability to discover information about health care costs, medical errors, or practice preferences, preferably before receiving the service. Transparency is being encouraged by the CMS, though transparency can be hampered by the fear of litigation or reprisal against the health care provider. The Patient Safety and Quality Improvement Act of 2005 addresses such concerns by encouraging health care providers to participate in developing and implementing evidence‐based improvement initiatives. The Act also highlights the importance of recognizing and responding to the underlying hazards and risks to patient safety. Establishing national health benchmarks, such as those in Healthy People 2020 (USDHHS, 2010), is another strategy by which to achieve and measure quality improvement.

Using the example of the management of heart disease, recent research findings illustrate the need for significant improvements to standardize the process of health care delivery. Each year, heart disease contributes to thousands of deaths. When evidence‐based standards are used to guide the care of the patient with heart disease. and aspirin and beta‐blockers are given to patients who have had a myocardial infarction, it can lower health care dollars and save lives associated with heart disease (Schulte, 2011). This is true, even if it is because aspirin use is being measured to assess provider performance (Williams, Schmaltz, Morton, Koss, & Loeb, 2005). Standardization of patient care can change the list of the top ten health care conditions, both in cost and mortality, by making patient care delivery more reliable ( Table 2.8).

Table 2.8 Top 10 Causes of Death—Cost and Death

Source: CDC. (2019). FastStats—Deaths and Mortality. Retrieved from www.cdc.gov/nchs/fastats/deaths.htm.

Performance and quality measurement is an essential component of health care improvement efforts. Performance and quality are measured to determine resource allocation, organize care delivery, assess clinician competency, and improve health care delivery processes. Hospitals and practitioners have been given past and present financial incentives to score well on measures of quality from both public and private health care payers. When the quality of care is measured, it improves (Brook, Kamberg, & McGlynn, 1996; Chassin & Galvin, 1998). possibly largely due to the Hawthorne effect, which has illustrated that observed activity shows improvement. Ramirez (2019) reports that more people receive evidence‐based care(EBC) for heart attack when they arrive at a hospital, hospital‐acquired conditions decreased from 2014 to 2017, that medicare 30‐day hospital readmission rates have declined, and that mortality rates within 30 days after hospital admission for heart attack, stroke, and pneumonia have decreased.

From 2003 to 2013, the mortality rate for deaths amenable to health care in the U.S. declined by about 17%. More recently, the rate has increased slightly.

Nursing leaders have also recognized the need to establish classifications that can be used to measure nursing care. Selected classifications are listed in Table 2.9.

Table 2.9 Selected Classification Systems (List compiled by R. Hughes).

Note that setting standards for appropriate care and guideline development should have a basis in validated measures of quality, using reliable performance data, and making appropriate adjustments in care delivery. Reliable methods and measures need to be developed and tested. Some practitioners have been resistant to their care delivery being measured because they have believed that it would interfere with their professionalism and autonomy. If this belief persists, the majority of health care delivery will not be measured.

Health care organizations are eligible to consider another framework for health care quality and to apply for the Malcolm Baldridge National Quality Award. The Health Care Criteria of the Malcolm Baldridge National Quality Award explores a hospitals mission and key objectives in seven critical areas: Leadership, Strategy, Customers, Measurements, Workforce, Operations, and Results. The Baldrige framework is based on core values and concepts that represent beliefs and behaviors found in high‐performing organizations. Baldrige works with public and private sector partners to address critical national needs related to long‐term success and sustainability, including cybersecurity risk management and excellence in US communities (Eastman, 2019).

Outcome measurementscan be done indicating an individual's clinical state, such as the severity of illness, course of illness, and the effect of interventions on the individual's clinical state. Outcome measures involving a patient's functional status evaluate a patient's ability to perform activities of daily living (ADLs). These can include measures of physical health in terms of function, mental and social health, cost of care, health care access, and general health perceptions. The measures can distinguish the concepts of physical and mental health and identify the five indicator categories of clinical status, functioning, physical symptoms, emotional status, and patient/family evaluation, and in Canada perceptions about quality of life. Selected quality‐of‐life measures include quality‐adjusted life years (QALYs), quality‐adjusted life expectancy(QALE), and quality‐adjusted healthy life years (QUALYs) (Drummond, Stoddart, & Torrance, 1994).

The assessment of health‐related quality of life(HR‐QOL) is an essential element of health care evaluation. Many generic and specific HR‐QOL instruments have been developed and include the Medical Outcomes Study 36‐Item Short Form (SF‐36) health survey; the Nottingham Health Profile(NHP); the Sickness Impact Profile(SIP); the Dartmouth Primary Care Cooperative Information Project(COOP) Charts; the Quality of Well‐Being(QWB) Scale; the Health Utilities Index(HUI); and the EuroQol Instrument (EQ‐5D) (Coons, Rao, Keininger, & Hays, 2000). The U.S. News & World Report (2019) reports that the country with the best quality of life is Canada, followed by Sweden and Denmark. The U.S. lags in sixth place.