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This is in response to Dr. Joseph Simone's column on "Patient Harm in Hospitals" (1/10/11 issue).

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I appreciate the attention to the evolving topic of medical errors contributing to patient harm. The highly acclaimed 1999 publication by the Institute of Medicine (IOM), To Err is Human: Building a Safer Health System (Linda T. Kohn, Janet M. Corrigan, and Molly S. Donaldson, eds. Washington, DC,: National Academy Press, 1999) heralded a consumer awareness of medical mistakes in the healthcare industry.


As the findings within the publication received national press coverage, patients were alarmed by the reported 98,000 annual medical errors occurring annually in a country that has long been recognized as being one of the world's best health care systems.


Predictably, policy-makers joined patients in demanding a renewed look at patient safety within the context of improving quality in our nation's health care system. The IOM's Committee on Quality of Health Care in America responded with the publication of "Crossing the Quality Chasm: A New Health System for the 21st Century" in 2001. These publications enlightened health care providers to examine their practices and develop fail-safe processes fully integrated into patient care.


The business models employed by healthcare CEOs and their executive staffs began to change as it became more difficult to keep the healthcare industry afloat. In a shifting economy, fundamental quality processes now intertwine with financial pillars. Today's practice of quality improvement in healthcare has evolved from the historic disciplines of quality control, quality management, and performance improvement. Entities like Robert Wood Johnson Foundation (RWJF) and Institute of Healthcare Improvement (IHI) are encouraging evidence-based practice guidelines to "transform care at the bedside."


Unfortunately, in 2011 the healthcare industry is still bridging the gap to patient safety issues. As Dr. Simone said in his article, "Lip service and the lack of empowerment are unacceptable at a time when the hospital has become the single most dangerous place for many patients." He further explained that "nurses are often in the best position to identify a structure or process that increases the risk of adverse events."


Numerous initiatives exist for nursing to impact patient centered change. First, IHI and RWJF designed an innovative approach to patient safety improvement. "Transforming Care at the Bedside" is a drive to create, test, and implement clinical changes to improve patient care and to improve staff satisfaction. These programs aggressively involve the bedside nurse who is trained in assessment and implementation.


Additionally, the National Council of State Boards of Nursing (NCSBN) has proposed a transition to practice model. The philosophy is to unite all baccalaureate academia curricula to include quality improvement (Figure). The hope is that by focusing on core elements, it will be possible to standardize key competencies that each nursing graduate will possess upon entry to clinical practice.


The Quality and Safety Education for Nurses (QSEN) also developed clinical core competencies for the undergraduate pre licensed nurse. One of these components is quality improvement. See the adapted QI template in the table, with all learning domains represented.


The objective is to identify clinical core competencies that each nurse should attain (

Definition Use data ... - Click to enlarge in new windowDefinition: Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems.

Recently, IOM/ RWJF collaborated on the Aligning Forces for Quality (AF4Q) program. The aim is to lift the overall quality of healthcare in targeted communities. The goal is to decrease racial and ethnic disparities, and the plan is to provide models for national reform. AF4Q asks the people who get care, give care, and pay for care to work together toward common, fundamental objectives to lead to better care.


This initiative is the largest of its kind ever undertaken by any United States philanthropy. Nurses will play a vital role in this accomplishment.


Summarily, the value based purchasing plan will affect hospital reimbursement from Centers for Medicare and Medicaid Services (CMS) in FY 2013. National Hospital Quality Measures (NHQM) AKA core measures, and meaningful use quality indicators will affect 70% the annual payment update (APU). Another 30% will be reflected by patient satisfaction ratings.


Physicians like Dr. Simone and nurses like me will have to remain united for hospitals to not only thrive, but to survive. Patient-centered care will focus on quality linked to financial incentives.


Patient safety strategies are not limited to only those listed here. I totally agree with Dr. Simone. Hospitals must "empower in-the-trenches nurses to make changes or try new, safer approaches than the 'same old, same old' way of doing things." Thank you again, Dr. Simone, for bringing this important topic to Oncology Times readers.




Risk Manager


Caldwell Memorial Hospital


Lenoir, NC


("I am fortunate to be the Risk Manager for a disproportionate share hospital (DSH) in a rural community setting. We have a culture of safety. Our employees do not fear reprisal or retaliation for reporting 'seemingly unsafe' conditions. We do not operate on a top-down structure. Our on-hands people contribute to process changes regularly.")