What is the best way for a nurse to improve quality of care?

On this page:

• Develop a knowledge-base for clinical care
• Build consistent clinical guidelines
• Implement processes to deliver the highest quality care

Evidence-based care

Nurses setting up nurse clinics need to be able to:

• articulate a knowledge base for the clinic
• adapt theoretical knowledge and clinical skills to the clinic
• demonstrate clinical reasoning in the application of clinical guidelines, and
• use evidence-based principles and guidelines.

There may be an existing service you can use to model your own nurse clinic. Visiting other services and even shadowing a nurse can be useful in developing your own model of care.

Clinical guidelines

Clinical guidelines and protocols help clinical staff make evidence-based decisions about the best care and treatment options for their patients.

Evidence-based clinical guidelines can be found in the following areas:

When establishing your clinic, consider conducting a literature search to review best practice, current guidelines and protocols specific to the clinical care that will be provided by the clinic. Documenting these practices and sharing them with clinic staff increases your clinic’s ability to deliver consistent care of the highest quality.

“Having the guidelines in place has been important in getting everybody on board."

Quality improvement

Embedding a quality improvement approach when establishing a nurse clinic will contribute to the delivery of good patient care, health care planning and service delivery through the measurement of the efficiency, viability and effectiveness of services. 

The Model for Improvement (MFI) is a well-established quality improvement approach which can be used as the framework for planning and implementing a nurse clinic. It can be applied to both small personal changes and large organisational changes, breaking down systems and processes into small steps which are then tested to ensure optimal performance.

Why use the Model for Improvement?

The MFI offers a number of benefits, including:

• providing a simple approach to making change that anyone can apply
• outlining a method to plan, develop and implement change
• reducing risk by testing small changes before wider implementation
• minimising resistance to change by starting small
• creating team unity around common goals
• maximising individual creativity and ideas from team members.

Use the strategies outlined below. 

Define the problem:

Understanding what the problem actually is and thinking about why there is a problem helps with developing goals. There are quality improvement tools that can assist. Tools and templates can be found on the Institute for Healthcare Improvement's website.

Think small and test:

Think about testing a change with one health worker, one GP or a select group of patients. Knowledge gained from this small test will help determine if the change had the desired effect and is suitable for wider implementation, or whether other changes should be tested. Ultimately, this process will improve the chances of making a successful change. 

Test each idea using a PDSA Cycle - template here

Use a whole-of-team approach:

To achieve effective change within any organisation, the individuals that will be affected by the change need to be involved throughout the process. The MFI empowers the entire team to work towards a common goal. Individual team members can contribute their ideas and, as a group, they can decide which ideas to test. 

Share the successes as well as the failures.

The MFI is based on learning. In a team, it is important to share and celebrate successes. It is equally important to discuss the things that did not work so the team can learn and test new approaches.  

Escalating healthcare costs, heightened awareness of medical errors, and a higher-than-ever number of insured Americans have drawn attention to the need for quality improvement in US healthcare. Today, many efforts around patient outcomes and safety, care coordination, efficiency, and cost-cutting are underway and care redesign initiatives are being evaluated to guide future healthcare quality improvements. The following tips may aid you in your healthcare improvement efforts.

1) Analyze your data and outcomes

As noted management expert, Peter Drucker, famously said, “If you cannot measure it, you cannot manage it.” Before you can begin to make improvements in health care, you first need to know what opportunities exist for improvement and then establish baseline outcomes. Next, look at trends and statistics from electronic health records, outcomes studies, and other data source to identify key areas in need of improvement.

Escalating costs have drawn attention to the need for quality improvement in US health care.

2) Set goals

Based on findings from the above exercise, set concrete and measurable goals in the areas you identify as most in need of improvement. These should be precise and quantitative in nature. The Institute of Medicine (IOM) outlined six aims for improvement, or pillars of quality healthcare that can guide your improvement goal-setting. According to the Institute for Healthcare Improvement (IHI), healthcare should be:

• Safe: Avoid injuries to patients from the care that is intended to help them.
• Effective: Match care to science; avoid overuse of ineffective care and underuse of effective care.
• Patient-Centered: Honor the individual and respect choice.
• Timely: Reduce waiting for both patients and those who give care.
• Efficient: Reduce waste.
• Equitable: Close racial and ethnic gaps in health status.

3) Create a balanced team

An effective team should be comprised of members from different backgrounds, with varied skills and experience levels. According to the IHI, forming a balanced team is one of the primary steps in the improvement process. The team should include a senior leader who can advise, provide oversight, and advocate for the team; a clinical expert who has the background necessary to make informed clinical decisions; and a project manager who can accomplish day-to-day tasks and keep the team on track.

4) Include Human Factors Inputs

As defined by the Human Factors and Ergonomics Society, human factors is a body of knowledge about human abilities, human limitations, and other characteristics that are relevant to design. Human factors engineering is the application of human factors information to the design of tools, machines, systems, tasks, jobs, and environments for safe, comfortable, and effective human use. These relate closely to quality improvement.

Some key human factors principles include avoiding reliance on memory, standardizing procedures, and using protocols and checklists. According to theNational Center for Human Factors in Healthcare, consideration of human factors in the design of healthcare systems and processes has many benefits, including more efficient care processes, enhanced communication between medical providers, better understanding of a patient’s medical condition, reduced risk of medical device and health IT-related errors, improved patient outcomes, and cost-savings.

5) Create an executable plan

To accomplish your goals in a timely and effective manner, you must create an achievable improvement plan. This includes specific measures, protocols for attaining those measurements, and specific definitions for improvement which will be taken from your goal setting and data analysis work. Be sure to have an organized system for tracking your data and measurements. The Health Resources and Services Administration provides detailed instructions and steps to developing and implementing a healthcare quality improvement plan on their website. You can also view our guide on project management for healthcare professionals.

6) Become Familiar with the PDSA cycle

The IHI recommends the use of the Model for Improvement as a framework to guide improvement efforts. According to IHI, the model, developed by Associates in Process Improvement, is “a simple, yet powerful tool for accelerating improvement.” The core of the model is the Plan-Do-Study-Act (PDSA) cycle, to test quality or improvement-related changes in clinical settings. By planning then enacting a change, observing results, and then acting on what is learned, one is able to discern which changes are effective. This cycle essentially mimics the steps of the scientific method, but is adapted for action-oriented learning.

7) Communicate goals and progress

Once your plan is underway, be sure to communicate with your team and with your organization at large. Share milestones both large and small as well as setbacks. Congratulate those who have contributed and made an impact on your progress. Your plan is more likely to succeed when staff are engaged.

8) Research other organizations and collaborate

Certain websites such as Patient Care Link allow consumers and healthcare industry workers to view hospital data and trends. Review data and see which organizations excel in a particular area in which you’re looking to improve. Research online and in the literature, and reach out to see if you can learn from their quality improvement programs. Most organizations are open to sharing this information for the greater good of patients.

Learn More

In its annual report to Congress, the Agency for Healthcare Research and Quality (AHRQ) reported promising improvements in healthcare quality as a result of improvement efforts nationwide. Some of their findings included lower patient death rates, higher vaccination rates, and improved patient-provider communication. Still, according to AHRQ, quality problems persist, such as variation in services, underuse, overuse or misuse of services, and disparities in quality—making healthcare quality improvement efforts all the more important.

For more information about healthcare quality improvement and an in-depth update on the state of healthcare quality in the US, read our article entitled An Update on United States Healthcare Quality Improvement Efforts. For an overview of successful improvement efforts, read an essay published in Health Affairs entitled Improving Quality and Safety.

Harvard T.H. Chan School of Public Health offers Leadership Strategies for Evolving Health Care Executives, a leadership program focused on improving health care. To learn more about this opportunity, click here.