1. Hader, Richard RN, CNA, CHE, CPHQ, PhD, FAAN, Editor-in-Chief
  2. Senior Vice President and Chief Nurse Officer

Article Content

You've recently reviewed your performance improvement report for your assigned area of responsibility, and the results appear to be pretty good. Most of the outcomes indicate that your department's performance meets national benchmark targets at least 75% of the time. You've correctly interpreted that your department's performance is in the top quartile of the country.

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Given this, you feel confident, congratulate the staff, celebrate, and consequently drop indicators from your quality improvement plan because of consistently good results. After all, the indicators demonstrate the probability that three of four patients are receiving good care. What, then, happened to the expectation of good care being provided to the fourth patient? Is achieving desired benchmark results sufficient if a lower care standard is provided to one of every four patients? I'd propose that the delivery of good care might not be good enough.


We've heard it before: preservation of autonomous medical and nursing practice, lack of resources, unclear expectations, and insufficient data-all rationales for the delivery of less than excellent care. Dismissing the active implementation of standing evidence-based protocols is no longer acceptable because individual practitioners prefer to deliver care based in a framework of habit, not scientific fact. Providing care that's not based in science will minimize the opportunity for positive outcomes, potentially enhance clinical complications, and exacerbate the drain of already limited resources.


Medical and nursing science offers evidence that supports practices such as not shaving an operative sight, tight glycemic protocols for the critically ill, appropriate timing of antibiotic therapy in operative patients, and active prevention of deep vein thrombosis in immobile patients. But unfortunately, these simple practices prove extremely difficult to implement in the practice setting. Why does it take so long to make these changes? As nurse leaders, we need to take action in rolling out and monitoring these scientifically proven standards-patient lives are at risk.


Of course achieving a positive financial bottom line is necessary for your organization's success. But too often, we narrowly focus on meeting or exceeding financial targets while neglecting the discipline necessary to fully analyze the cost-benefit relationship of supporting additional resources to enhance care quality. Again, as nurse leaders we must be active participants in working with bedside practitioners to determine the necessary resources for excellent care provision. For example, if your performance improvement data reveals that pressure ulcer rates are escalating, then consider hiring a wound care nurse practitioner or ordering better skin breakdown supplies. Make it happen: Introduce and execute a business plan that provides the appropriate allocation of resources. Your plan should contain measures of success so that you're confident the goal is being achieved. Track this data vigilantly to ensure an appropriate return on investment.


You'll realize success only if processes are in place that measure performance. Encourage nurses to partner with information technology and healthcare finance specialists to implement strategies for easier data analysis. To make this step less cumbersome, invest in technological tools that assist with quantifying results, such as software with the ability to data mine.


And don't overlook the importance of staff nurse input. Unit-based shared governance councils are a great way to educate and share information regarding evidence-based practices. Get your bedside nurses involved and good care will transform to great care.