- Email: [email protected]
Undertaking the Quality Journey
Undertaking the Quality Journey Joan Bowman, RN, BSN, MPA, CCM, and Maureen Boshier, MSN, RN, MBA, FACHE
M
any hospitals across the country are embarking on the “quality journey,” pursuing
significant and lasting improvements in the processes of care delivery. For some organizations, this endeavor may be related to the pursuit of major recognition for improvements in quality and efficiency such as: • Magnet™ status, the award given by the American Nurses Credentialing Center (an affiliate of the American Nurses Association) to hospitals that meet a set of criteria that measure strength and quality of their nursing. • Malcolm Baldrige National Quality Award, the nation’s highest presidential honor of organizational performance excellence. This universally recognized quality award is not specific to healthcare.
ther acute-care quality initiatives may be in response to regulatory changes such as the recent Medicare announcement that, as of October 1, 2008, Medicare will no longer pay for care required for conditions that could reasonably have been prevented.Among such conditions are decubitus ulcers, injuries caused by falls, and infections from prolonged use of catheters. At Presbyterian Healthcare Services, a not-for-profit system of hospitals, a health plan, and a growing medical group in New Mexico, pursuit of the Baldrige award provided criteria that are an organizing framework to improve quality.“For us, Baldrige has really led to a focus on process management as well as
O
44
Nurse Leader
process improvement. It’s not just outcome measurement; it’s also knowing that your processes are functioning and in control. The staff knows how you’re doing right now: how many patients are waiting for discharge and for how long; how many patients are waiting for a bed; if a person is at risk for a fall, and what measures have been taken,” explained Kathy Davis, RN, MBA, CNAA, senior vice president of Patient Care Services and Chief Nursing Officer. “Quality is coming increasingly into the limelight as consumers become more informed about where to go and the type of information to ask their providers.When they are considering surgery, for example, they are more analytical in
June 2009
their approach,” added Cathy Munn, MPH, RHIA, CPHQ, president-elect of the National Association of Healthcare Quality (NAHQ), who is also medical services manager for DST Health Solutions in Birmingham,Ala. THE QUALITY JOURNEY The quality journey can be described in terms of the following milestones, visible along the way: • Establishing partnerships for the care of the patient • Collecting data and measuring outcomes • Focusing on patient-centered care and shared decision making • Changing organizational cultures Each milestone will be visited in the following sections. ESTABLISHING PARTNERSHIPS Whatever the impetus, the quality journey involves a longterm commitment to measurable, sustainable change impacting the process of care delivery; and altering the culture of the organization.Although the quality journey is often initiated at the senior management level, practitioners at all levels are called upon to take a leadership role, especially nurses and case managers because they play a central part in all quality initiatives. For nurse leaders and case managers, the pursuit of quality is closely aligned with the objectives of patient-centered care, a key element in practice. Throughout the quality journey, nurses and case managers demonstrate leadership and contribute unique skills and expertise such as their ability to forge partnerships with each other, with various members of the healthcare team and, most importantly, with patients and families. “The quality journey relies on a series of multiple partnerships that involve the healthcare team. It cannot be taken in isolation,” states Jeannette Wrona Klemczak, RN,MSN, BSN, chief nurse executive for the State of Michigan. “Patients and families are also team members. They are part of the quality equation as they are able to respond to the care they receive and take that care and teaching from their inpatient experience or ambulatory care visit back into the community.” At all times, the pursuit of good patient outcomes and the principles of patient-centered care are primary objectives in case management work.These objectives provide a base from which leaders in nursing and case management collaborate to discuss their work processes. Case managers advocate for patients within their practice and focus on achieving quality standards every day by using information and evidence-based care practices. For case managers, quality is inseparable from ethical practice, particularly patient advocacy, which is a central precept of case management.This approach to care resonates strongly with the basic values of all nurses, from administrators and managers to those who work at the patient’s bedside. For example, a case manager knows that when a frail elderly person is kept in bed, the individual will likely debilitate further, increasing the likelihood of a fall.As a result of data measurement and analysis, the case manager may be aware of
www.nurseleader.com
At all times, the pursuit of good patient outcomes and the principles of patient-centered care are primary objectives in case management work.
issues involving the care of frail elderly patients that require interventions to help prevent falls.This prompts the case manager to establish a partnership with the bedside nurse so the plan of care includes increasing activity with safe walking and other planned interventions to help prevent falls, such as anticipating the patient’s need to use the bathroom rather than waiting for the individual to call.Through collaboration, the case manager and the caregiver nurse work toward maintaining the patient’s physical functionality. “Collaboration and partnership are vital.Although case management as a practice is broader than nursing, it’s important that nursing case management not be segregated from the rest of nursing. If that happens, it can have a negative impact on quality,” said Gay Landstrom, director of nursing practice for Michigan-based Trinity Health, which operates hospitals and healthcare facilities in several states.“We have to collaborate around the work we’re trying to accomplish.We have to be partners in order to create the kind of practice and outcomes deserving of Magnet designation.” COLLECTING DATA, MEASURING OUTCOMES As an area of advanced practice, case management attracts many nurses (as well as other healthcare professionals) who bring specialized skills to the team working on quality outcomes. Unique to case management is the emphasis on managing processes, not personnel or staff—a key difference in comparison to other advanced practice roles.The hallmark of quality is sound processes. By focusing on the process of care delivery, case managers contribute directly to quality improvement. Many organizations emphasize utilization management as a means to improve cost-effectiveness, but case managers understand that a balance is needed between quality and utilization management. Indeed, overseeing quality in order to achieve good patient outcomes should automatically result in cost savings because of a reduction in errors, elimination of unnecessary procedures, and greater efficiency in the delivery of care.
Nurse Leader
45
The admission review process is also a data-rich opportunity for planning quality outcomes that address prevention of hospitalacquired syndromes.
In most organizations, a case manager or a skilled utilization review professional examines the medical record of every person who comes through the hospital door, whether for a routine or emergency admission.The purpose of the review is to determine the medical necessity or appropriateness of the admission. As part of the quality journey, the case manager reviews admissions to ensure appropriate information has been gathered and the assessment of the patient is complete. The admission review process is also a data-rich opportunity for planning quality outcomes that address prevention of hospital-acquired syndromes.Through retro-reviews, case managers look for incidents in the care process that might contribute to the development of a hospital-acquired syndrome, such as an infection, a decubitus ulcer, or a fall. The case manager may not see the patient in the emergency department, but has almost immediate access to the information that the physician or nurse has generated.Assuming a leadership role, the case manager who reviews an admission can seek additional information or raise questions about what has been documented, especially information that relates to “present-onadmission” conditions.These conditions are vitally important under the new Medicare rules, as Medicare will not cover treatment for patients who acquire a hospital-induced syndrome.To minimize financial risk and improve the quality of care delivery, hospitals must carefully document any and all conditions that are present when patients are admitted. As the admission review example shows, the case manager champions the acquisition and trending analysis of data to point to trends and benchmarks that are essential to improving care.As the care process is analyzed, the case manager can identify those events and circumstances that undermine quality and impact reimbursement as well. Some of the data that would be collected related to process improvement could include, for example: • The incidence of postoperative infections • The number of patients admitted from nursing homes with decubitus ulcers
46
Nurse Leader
• The number of patient falls and injuries • The number of cases of pneumonia occurring in intubated patients on respirators Using the example of planned interventions for frail elderly patients, a case manager who understands the value of data-driven decision making can collect information about patients, aggregate the data to show trends, and present that information to the department manager to highlight potential opportunities for improvements in multiple care processes. In this scenario, the case manager functions as an integral part of a team and contributes to improved outcomes by using and sharing information available through a comprehensive data collection process.The aggregation of data into meaningful tracking and trending reports feeds quality processes in hospitals. Data aggregation also contributes to a “feedback loop” in which the case manager has an essential role in providing valuable information to the treatment team.“The feedback loop is continuous and also circular, which is often the missing link,” observed Klemczak.“Once patients are out the door of the hospital, they are ‘gone.’ However, it can be the case manager who loops back to the treatment team with data about patients’ experiences after discharge. If there aren’t metrics—which is where the data aggregation comes in— then how will the treatment team know to do something different the next time? Quality is just a word unless there are metrics and outcomes.” Quality processes, in turn, influence decision making regarding allocation and distribution of care resources. For example, after a review of patient care data, the decision may be to require removal of a Foley catheter 24 hours after surgery to reduce the risk of a bladder infection.Throughout data collection and aggregation, case managers pay close attention to key quality indicators in order to plan improvements to the overall efficiency and effectiveness of care delivery, thus making a positive impact on clinical, patient satisfaction, and financial outcomes. Case managers are noted for contributing to the quality journey through their commitment to evidence-based practice and data-driven decision making. Case managers are also expected to be aware of what is published in professional journals and the literature regarding the process of care delivery.They can make that information readily available to colleagues to incorporate into the plan of care. FOCUSING ON SHARED DECISION MAKING AND PATIENTCENTERED CARE Another example of leadership in the pursuit of improved quality is the emphasis on shared decision making, which is promoted by both nurses and case managers. Shared decision making moves away from the medical model of physician orders to a patient-centric care model that includes patients in decision making regarding their own healthcare. Shared decision making requires input from case managers, nurses, and other clinicians and caregivers, such as pharmacists, occupational therapists, physical therapists, and nutritionists. Hospitals selected for Magnet and Baldrige award status have
June 2009
cultures of patient-centered care that rely on strong collaboration among the members of interdisciplinary teams. The interdisciplinary approach to shared decision making is therefore aligned with pursuit of Magnet status, and the role of staff nurses in shaping research-based nursing practice to advance nursing care is supported. Magnet hospitals encourage open communication, collaboration, and collegiality between nurses and other members of the healthcare team to attain the best patient outcomes and an optimal work environment.As part of the Magnet journey, in particular, shared decision making is congruent to nursing practice and reflects a patient-centered model of care. Shared decision making is also germane to case management, which facilitates communication and sharing information about best practices among various members of the treatment team. Case managers do very well engaging patients and families as key decision makers in their health care. This isconsistent with the perspective of informed consumers in the quality journey. It is also compatible with shared decision making and the patient-centered model of care, which nurse managers and case managers support through their practice: i.e., nurses at the bedside know what’s best for their patients and act on that knowledge with the authority and resources to do so. Further, case managers serve as stewards of care resources, overseeing the effective application of resources to patient needs, a natural linkage to quality. In its simplest terms, stewardship is doing the right thing efficiently, a standard that automatically leads to better quality. Stewardship is an active part of the care process at Presbyterian Healthcare. Davis noted that the “Lean Six Sigma” approach taken at Presbyterian Healthcare in pursuit of the Baldrige award seeks to improve the deployment and utilization of resources. “The ‘lean’ piece is taking out the non–value-added parts of any process.The ‘Six Sigma’ piece is error-proofing, making sure that defects are eliminated in the process so that it becomes highly reliable,” she said.
whether the words in the mission statement are what people are really committed to.” In summary, the quality journey never reaches its destination, but continues to circle back to visit and strengthen the milestones of: • Partnerships • Data collection and measurement • Shared decision making and patient-centered care, and • Organizational culture change The success of the journey is reflected in patient experience as the true test of an organization’s depth of commitment to the quality journey. Regardless of awards or accolades received, there is no end point to what is achieved. The pursuit of quality truly is a journey; not a destination.To undertake such an endeavor requires a team, championed and empowered by senior management, and extending to every department and every facet of the organization. Critical players on the team are the nursing and case management leaders who, through their specific contributions and collaborative efforts, bring powerful forces to the pursuit of quality goals. NL Joan Bowman, RN, BSN, MPA, CCM, is a commissioner of the Commission for Case Manager Certification and director of patient support services at Sparrow Health System in Lansing, MI. Maureen Boshier, MSN, RN, MBA, FACHE, is also a CCMC commissioner, the former vice president for operations at Eastern Virginia Medical School in Norfolk,VA, and former president and CEO of the New Mexico Hospitals and Health Systems Association.They can be reached at [email protected] 1541-4612/2009/ $ See front matter Copyright 2009 by Mosby Inc. All rights reserved. doi:10.1016/j.mnl/2009.04.001
CHANGING ORGANIZATIONAL CULTURES The pursuit of quality is a journey of improvement and change. Organizations committed to this quality journey have chosen a proactive rather than a reactive approach. It is not a response to an isolated change or a single item in quarterly data; rather it is the long view of improving processes for the ultimate goal of excellent patient outcomes. Quality is not a task that can be checked off a list of things to be accomplished. Quality underscores what must be done every day. For those organizations with a commitment to making measurable improvements in the delivery of care, quality becomes imbedded in the culture. “You can have anything you want on your logo or tagline. The real difference will be when people access your facility for care,” Munn added.“They are going to be able to determine very quickly if you really live your mission of quality every day; if you are all about caring for people and meeting their needs. It will come across in the first five minutes
www.nurseleader.com
Nurse Leader
47
M
any hospitals across the country are embarking on the “quality journey,” pursuing
significant and lasting improvements in the processes of care delivery. For some organizations, this endeavor may be related to the pursuit of major recognition for improvements in quality and efficiency such as: • Magnet™ status, the award given by the American Nurses Credentialing Center (an affiliate of the American Nurses Association) to hospitals that meet a set of criteria that measure strength and quality of their nursing. • Malcolm Baldrige National Quality Award, the nation’s highest presidential honor of organizational performance excellence. This universally recognized quality award is not specific to healthcare.
ther acute-care quality initiatives may be in response to regulatory changes such as the recent Medicare announcement that, as of October 1, 2008, Medicare will no longer pay for care required for conditions that could reasonably have been prevented.Among such conditions are decubitus ulcers, injuries caused by falls, and infections from prolonged use of catheters. At Presbyterian Healthcare Services, a not-for-profit system of hospitals, a health plan, and a growing medical group in New Mexico, pursuit of the Baldrige award provided criteria that are an organizing framework to improve quality.“For us, Baldrige has really led to a focus on process management as well as
O
44
Nurse Leader
process improvement. It’s not just outcome measurement; it’s also knowing that your processes are functioning and in control. The staff knows how you’re doing right now: how many patients are waiting for discharge and for how long; how many patients are waiting for a bed; if a person is at risk for a fall, and what measures have been taken,” explained Kathy Davis, RN, MBA, CNAA, senior vice president of Patient Care Services and Chief Nursing Officer. “Quality is coming increasingly into the limelight as consumers become more informed about where to go and the type of information to ask their providers.When they are considering surgery, for example, they are more analytical in
June 2009
their approach,” added Cathy Munn, MPH, RHIA, CPHQ, president-elect of the National Association of Healthcare Quality (NAHQ), who is also medical services manager for DST Health Solutions in Birmingham,Ala. THE QUALITY JOURNEY The quality journey can be described in terms of the following milestones, visible along the way: • Establishing partnerships for the care of the patient • Collecting data and measuring outcomes • Focusing on patient-centered care and shared decision making • Changing organizational cultures Each milestone will be visited in the following sections. ESTABLISHING PARTNERSHIPS Whatever the impetus, the quality journey involves a longterm commitment to measurable, sustainable change impacting the process of care delivery; and altering the culture of the organization.Although the quality journey is often initiated at the senior management level, practitioners at all levels are called upon to take a leadership role, especially nurses and case managers because they play a central part in all quality initiatives. For nurse leaders and case managers, the pursuit of quality is closely aligned with the objectives of patient-centered care, a key element in practice. Throughout the quality journey, nurses and case managers demonstrate leadership and contribute unique skills and expertise such as their ability to forge partnerships with each other, with various members of the healthcare team and, most importantly, with patients and families. “The quality journey relies on a series of multiple partnerships that involve the healthcare team. It cannot be taken in isolation,” states Jeannette Wrona Klemczak, RN,MSN, BSN, chief nurse executive for the State of Michigan. “Patients and families are also team members. They are part of the quality equation as they are able to respond to the care they receive and take that care and teaching from their inpatient experience or ambulatory care visit back into the community.” At all times, the pursuit of good patient outcomes and the principles of patient-centered care are primary objectives in case management work.These objectives provide a base from which leaders in nursing and case management collaborate to discuss their work processes. Case managers advocate for patients within their practice and focus on achieving quality standards every day by using information and evidence-based care practices. For case managers, quality is inseparable from ethical practice, particularly patient advocacy, which is a central precept of case management.This approach to care resonates strongly with the basic values of all nurses, from administrators and managers to those who work at the patient’s bedside. For example, a case manager knows that when a frail elderly person is kept in bed, the individual will likely debilitate further, increasing the likelihood of a fall.As a result of data measurement and analysis, the case manager may be aware of
www.nurseleader.com
At all times, the pursuit of good patient outcomes and the principles of patient-centered care are primary objectives in case management work.
issues involving the care of frail elderly patients that require interventions to help prevent falls.This prompts the case manager to establish a partnership with the bedside nurse so the plan of care includes increasing activity with safe walking and other planned interventions to help prevent falls, such as anticipating the patient’s need to use the bathroom rather than waiting for the individual to call.Through collaboration, the case manager and the caregiver nurse work toward maintaining the patient’s physical functionality. “Collaboration and partnership are vital.Although case management as a practice is broader than nursing, it’s important that nursing case management not be segregated from the rest of nursing. If that happens, it can have a negative impact on quality,” said Gay Landstrom, director of nursing practice for Michigan-based Trinity Health, which operates hospitals and healthcare facilities in several states.“We have to collaborate around the work we’re trying to accomplish.We have to be partners in order to create the kind of practice and outcomes deserving of Magnet designation.” COLLECTING DATA, MEASURING OUTCOMES As an area of advanced practice, case management attracts many nurses (as well as other healthcare professionals) who bring specialized skills to the team working on quality outcomes. Unique to case management is the emphasis on managing processes, not personnel or staff—a key difference in comparison to other advanced practice roles.The hallmark of quality is sound processes. By focusing on the process of care delivery, case managers contribute directly to quality improvement. Many organizations emphasize utilization management as a means to improve cost-effectiveness, but case managers understand that a balance is needed between quality and utilization management. Indeed, overseeing quality in order to achieve good patient outcomes should automatically result in cost savings because of a reduction in errors, elimination of unnecessary procedures, and greater efficiency in the delivery of care.
Nurse Leader
45
The admission review process is also a data-rich opportunity for planning quality outcomes that address prevention of hospitalacquired syndromes.
In most organizations, a case manager or a skilled utilization review professional examines the medical record of every person who comes through the hospital door, whether for a routine or emergency admission.The purpose of the review is to determine the medical necessity or appropriateness of the admission. As part of the quality journey, the case manager reviews admissions to ensure appropriate information has been gathered and the assessment of the patient is complete. The admission review process is also a data-rich opportunity for planning quality outcomes that address prevention of hospital-acquired syndromes.Through retro-reviews, case managers look for incidents in the care process that might contribute to the development of a hospital-acquired syndrome, such as an infection, a decubitus ulcer, or a fall. The case manager may not see the patient in the emergency department, but has almost immediate access to the information that the physician or nurse has generated.Assuming a leadership role, the case manager who reviews an admission can seek additional information or raise questions about what has been documented, especially information that relates to “present-onadmission” conditions.These conditions are vitally important under the new Medicare rules, as Medicare will not cover treatment for patients who acquire a hospital-induced syndrome.To minimize financial risk and improve the quality of care delivery, hospitals must carefully document any and all conditions that are present when patients are admitted. As the admission review example shows, the case manager champions the acquisition and trending analysis of data to point to trends and benchmarks that are essential to improving care.As the care process is analyzed, the case manager can identify those events and circumstances that undermine quality and impact reimbursement as well. Some of the data that would be collected related to process improvement could include, for example: • The incidence of postoperative infections • The number of patients admitted from nursing homes with decubitus ulcers
46
Nurse Leader
• The number of patient falls and injuries • The number of cases of pneumonia occurring in intubated patients on respirators Using the example of planned interventions for frail elderly patients, a case manager who understands the value of data-driven decision making can collect information about patients, aggregate the data to show trends, and present that information to the department manager to highlight potential opportunities for improvements in multiple care processes. In this scenario, the case manager functions as an integral part of a team and contributes to improved outcomes by using and sharing information available through a comprehensive data collection process.The aggregation of data into meaningful tracking and trending reports feeds quality processes in hospitals. Data aggregation also contributes to a “feedback loop” in which the case manager has an essential role in providing valuable information to the treatment team.“The feedback loop is continuous and also circular, which is often the missing link,” observed Klemczak.“Once patients are out the door of the hospital, they are ‘gone.’ However, it can be the case manager who loops back to the treatment team with data about patients’ experiences after discharge. If there aren’t metrics—which is where the data aggregation comes in— then how will the treatment team know to do something different the next time? Quality is just a word unless there are metrics and outcomes.” Quality processes, in turn, influence decision making regarding allocation and distribution of care resources. For example, after a review of patient care data, the decision may be to require removal of a Foley catheter 24 hours after surgery to reduce the risk of a bladder infection.Throughout data collection and aggregation, case managers pay close attention to key quality indicators in order to plan improvements to the overall efficiency and effectiveness of care delivery, thus making a positive impact on clinical, patient satisfaction, and financial outcomes. Case managers are noted for contributing to the quality journey through their commitment to evidence-based practice and data-driven decision making. Case managers are also expected to be aware of what is published in professional journals and the literature regarding the process of care delivery.They can make that information readily available to colleagues to incorporate into the plan of care. FOCUSING ON SHARED DECISION MAKING AND PATIENTCENTERED CARE Another example of leadership in the pursuit of improved quality is the emphasis on shared decision making, which is promoted by both nurses and case managers. Shared decision making moves away from the medical model of physician orders to a patient-centric care model that includes patients in decision making regarding their own healthcare. Shared decision making requires input from case managers, nurses, and other clinicians and caregivers, such as pharmacists, occupational therapists, physical therapists, and nutritionists. Hospitals selected for Magnet and Baldrige award status have
June 2009
cultures of patient-centered care that rely on strong collaboration among the members of interdisciplinary teams. The interdisciplinary approach to shared decision making is therefore aligned with pursuit of Magnet status, and the role of staff nurses in shaping research-based nursing practice to advance nursing care is supported. Magnet hospitals encourage open communication, collaboration, and collegiality between nurses and other members of the healthcare team to attain the best patient outcomes and an optimal work environment.As part of the Magnet journey, in particular, shared decision making is congruent to nursing practice and reflects a patient-centered model of care. Shared decision making is also germane to case management, which facilitates communication and sharing information about best practices among various members of the treatment team. Case managers do very well engaging patients and families as key decision makers in their health care. This isconsistent with the perspective of informed consumers in the quality journey. It is also compatible with shared decision making and the patient-centered model of care, which nurse managers and case managers support through their practice: i.e., nurses at the bedside know what’s best for their patients and act on that knowledge with the authority and resources to do so. Further, case managers serve as stewards of care resources, overseeing the effective application of resources to patient needs, a natural linkage to quality. In its simplest terms, stewardship is doing the right thing efficiently, a standard that automatically leads to better quality. Stewardship is an active part of the care process at Presbyterian Healthcare. Davis noted that the “Lean Six Sigma” approach taken at Presbyterian Healthcare in pursuit of the Baldrige award seeks to improve the deployment and utilization of resources. “The ‘lean’ piece is taking out the non–value-added parts of any process.The ‘Six Sigma’ piece is error-proofing, making sure that defects are eliminated in the process so that it becomes highly reliable,” she said.
whether the words in the mission statement are what people are really committed to.” In summary, the quality journey never reaches its destination, but continues to circle back to visit and strengthen the milestones of: • Partnerships • Data collection and measurement • Shared decision making and patient-centered care, and • Organizational culture change The success of the journey is reflected in patient experience as the true test of an organization’s depth of commitment to the quality journey. Regardless of awards or accolades received, there is no end point to what is achieved. The pursuit of quality truly is a journey; not a destination.To undertake such an endeavor requires a team, championed and empowered by senior management, and extending to every department and every facet of the organization. Critical players on the team are the nursing and case management leaders who, through their specific contributions and collaborative efforts, bring powerful forces to the pursuit of quality goals. NL Joan Bowman, RN, BSN, MPA, CCM, is a commissioner of the Commission for Case Manager Certification and director of patient support services at Sparrow Health System in Lansing, MI. Maureen Boshier, MSN, RN, MBA, FACHE, is also a CCMC commissioner, the former vice president for operations at Eastern Virginia Medical School in Norfolk,VA, and former president and CEO of the New Mexico Hospitals and Health Systems Association.They can be reached at [email protected] 1541-4612/2009/ $ See front matter Copyright 2009 by Mosby Inc. All rights reserved. doi:10.1016/j.mnl/2009.04.001
CHANGING ORGANIZATIONAL CULTURES The pursuit of quality is a journey of improvement and change. Organizations committed to this quality journey have chosen a proactive rather than a reactive approach. It is not a response to an isolated change or a single item in quarterly data; rather it is the long view of improving processes for the ultimate goal of excellent patient outcomes. Quality is not a task that can be checked off a list of things to be accomplished. Quality underscores what must be done every day. For those organizations with a commitment to making measurable improvements in the delivery of care, quality becomes imbedded in the culture. “You can have anything you want on your logo or tagline. The real difference will be when people access your facility for care,” Munn added.“They are going to be able to determine very quickly if you really live your mission of quality every day; if you are all about caring for people and meeting their needs. It will come across in the first five minutes
www.nurseleader.com
Nurse Leader
47