Nursing Quality Structure to Improve Nursing Outcomes

Purpose:
To describe a nursing quality infrastructure that disseminates NDNQI and other nurse sensitive indicators and drives quality improvement goals at a unit, service-line, and organizational level.

Significance:
Complex nursing quality and safety problems cannot be successfully addressed within a healthcare system without a robust nursing quality structure to support on-going quality improvement initiatives.

Strategy and Implementation:
In order to achieve sustainable improvement in the quality of nursing care, Anne Arundel Medical Center (AAMC) recognized the need to build a nursing quality infrastructure where quality improvement opportunities could be identified, addressed, and evaluated at multiple levels within the organization. AAMC implemented a three tiered nursing quality structure in which the unit-level nursing quality councils report to the service-line nursing quality councils, which in turn link to the organization-wide nursing quality council. From the unit level to the organizational level NDNQI data and other nurse sensitive data is disseminated, problems are identified, and quality improvement projects are implemented and evaluated. The process of implementation involved staff training and education, development of NDNQI score cards, standardization of agendas, and on-going support from the Director of Nursing Quality and Research, and nursing leadership.

Evaluation:
The nursing quality structure has thrived since implementation two years ago. Membership has grown as the councils have gained organizational wide visibility, recognition, and demonstrated their effectiveness in improving unit quality. Improvements in mutiple nurse senstive outcomes have occurred.

Implications for Practice:
Sustainable positive nursing outcomes can be achieved by the development of a nursing quality infrastructure where nursing sensitive data is communicated, nursing practice issues are addressed, and quality improvement projects are implemented.