The current global healthcare environment requires measurement of quality outcomes as evidence of safe, effective patient care and organizational performance. Healthcare organizations are further challenged to demonstrate sustainability of quality outcomes within the complex and ever-changing healthcare environment. Nurses, as members of interprofessional teams, are in a unique position to lead and participate in quality improvement and sustainability while simultaneously providing care on the front line. Using the Magnet^(R) model and empirical outcomes (EO) component, nurses initiate a deliberate approach using outcome measures to identify, drive, and implement improvements to address clinical problems and advance quality. The EO component emphasizes implementation of up-to-date best practice interventions and measurement of outcomes as an important determinant of the quality of care delivered to patients. Data collection and demonstration of a minimum of 3 post-intervention data points are required to demonstrate trended improvement.1 In addition, the ability to connect quality improvement efforts with the realities of nurses' work that occurs moment to moment and shift to shift in the complex healthcare environment requires a strong, ongoing effort for sustainable practices to continually improve the quality of care. Using a structured process to sustain improvements in quality outcomes is paramount to strengthen the professional practice of nursing and to ensure the ongoing delivery of safe and high-quality patient care. Researchers assert sustainability is not an outcome in and of itself but an ongoing process of supporting and managing the continuation and evolution of evidence-based practices over time.2 With the challenges of sustainability often reported as variable and suboptimal, this article describes key strategies for nursing leaders to sustain quality outcomes within a complex healthcare organization.

To sustain improvement in quality outcomes through nursing and interprofessional interventions at the point of care, consideration must be given to the key drivers of high-performance management systems. Leadership behaviors must support sustainability and performance improvement.3 Organizational structures and processes need to be present to manage quality control and quality improvement. It is essential the organization's work culture supports consistent execution of quality control.4 Organizations with robust quality improvement cultures and programs are better equipped to sustain improvements and quality outcomes.

Once the organizational key drivers have been established, nurse leaders at the point of care can enhance quality control and sustainability by using the following strategies: 1) standardization; 2) accountability; 3) visual management; 4) problem solving; 5) escalation; and 6) integration.4 Standardization of work contributes to quality control and maximizes sustainability. Organizations that clearly define role expectations, what to do, when to do it, and how to do it, are more likely to achieve reliability of the work across similar roles in different healthcare settings.4 Accountability is the measurement of work processes at the point of care against the established work standard set by the organization.4 Analysis of process measures allows nurse leaders to understand what actions are required to ensure consistency of the nurse practices.4 Trending performance data for process measures is integral to ultimately achieving the desired quality and patient outcome goals. Visual management systems make performance data continuously available to the staff doing the work, providing the opportunity for staff input.4 Nurse leaders and frontline nurses are trained in problem-solving methods and tools to address process variation.4 When a problem cannot be resolved at the front line, a process for escalation is necessary, because the issue may require additional support and resources or be outside the frontline nurse leader's scope. Finally, integration is central to quality control and sustainability across the organization.4 Strategic goals are aligned throughout the organization from the executive suite to the unit level. Using these key strategies, nurse leaders and clinical nurses are more likely to achieve performance and quality improvement sustainability.

The key objective of the Magnet^(R) model is to create a professional nursing care environment, which serves as a foundation for quality control and quality improvement.1 This professional nursing care environment includes and supports a resilient high-performance quality management program. Embedding key drivers and strategies found in a high-performance quality improvement culture provides a robust infrastructure for achieving sustained performance and quality outcomes. The EO component and sources of evidence examples demonstrating trended improvement in quality outcomes are a part of this infrastructure, with sustainability as an integral part of quality improvement in healthcare organizations. Today, more than ever, healthcare organizations are challenged to sustain quality improvement and outcomes because of the ever-evolving world of science and healthcare. As nursing leadership commits to quality improvement and elevating nursing practice, achieving and sustaining performance excellence at the point of care is essential.

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