SARS‐CoV‐2 pandemic, better known as COVID‐19. COVID‐19 has tested every aspect of the current health system and health care coverage. What have we discovered? That lack of any of these—political will, adhering to science, use of all available technology, or sufficient economic resources—results in poor or no policy when it comes to achieving common agreement on what is needed to provide safety for patients, families, health care workers, communities, and citizens. What can we use to understand this failing?
Such an approach to policy‐making portrays a model based upon rational decision‐making, which according to Stone (2012) includes multiple well‐identified steps: identifying objectives, identifying alternative courses of action for achieving objectives, predicting the possible consequences of each alternative, evaluating the possible consequences of each alternative, and selecting the alternative that maximizes the attainment of objectives. This approach is market driven; that is, society comes together because it wants something new or to fix problems. This seems so sensible: why wouldn’t this be effective, whether it results in legislation, standards, guidelines, regulation, or other actions that improve health care quality? As we have seen over the last decade with relation to the ACA, while society wanted to fix health care or the health insurance market, the objectives were in conflict, and neither the objectives nor the solutions were made clear to consumers. Stone, in her book Policy Paradox (2012), pinpoints the need for the Obama Administration to have portrayed the health insurance reform to Americans in a way that spoke to their emotions, in a way that convinced them that it would make their lives and their health care better.
We have seen in the four years 2016 to 2020, under a different Administration, and particularly in 2020, that the rational decision‐making process has been largely cast aside for an approach that Stone terms “political reasoning”—reasoning by metaphor and analogy. Political reasoning strives to get others to see a situation as one thing rather than another. A protest on Black Lives Matter Square in the Washington District of Columbia could be seen as a forum for public debate or as an emotional assault on vulnerable people. The COVID‐19 pandemic has been termed simultaneously a “health care crisis of enormous proportions” or a situation in which “the country is turning the corner.” The election campaign of 2020 could be another perfect example. Indeed, one voter defended on 60 Minutes her choice of candidate in these terms: “I don’t need my president to be warm and fuzzy and hug babies. My 401K is doing fine and that is what matters to me.”
In this chapter we explore nurses’ engagement in the policy‐making process utilizing the rational decision‐making approach, which provides a level of familiarity and reasonableness. However, we also begin to look at policy‐making through a lens of political reasoning, to understand how it is that we need to relate to the political will of the people we serve. Nurses’ ability to continue to be successful in influencing policy will require the adoption of both. Nurses do have somewhat of an advantage in the latter, in that their lived experiences at the front lines with patients and families generate passion and stories that allow them to be persuasive. It is up to nurses to use these opportunities to create the metaphors and analogies that inform a political community rather than only a market‐driven one.
The Landscape of Formal Stakeholders in the Ongoing Quality Dialogue
Many collective efforts have been initiated over the last 30 years to drive quality and safety improvement through policy channels. This chapter describes both formalized and innovative efforts that continue to grow out of a need to address health delivery challenges, using organizational structures and alliances whose missions were substantially focused on quality and safety. The list is necessarily broad and incorporates federal agencies as well as professional organizations and alliances. Certainly this list is not exhaustive; the intent has been to include those efforts in which nursing has or needs to have a voice in the formal agenda, solutions, and policy formulations. In addition, this chapter touches on some of the additional opportunities for policy input through regulation and rule‐making that inevitably emerge from massive policy enactment.
This chapter incorporates the result of three decades of effort, including the passage and implementation of the ACA and the many provisions within it that support health care quality and safety. It also speaks to the ongoing efforts to press forward with quality despite many political attempts to end the ACA. It includes other recent policy efforts to advance health and health care that focus on the health disparities that make federal and state efforts to improve quality fragmented at best. Efforts to modify reimbursement and minimize barriers to effective patient care delivery will also be examined.
Recent Efforts and Initiatives Supporting the Safety and Quality Movement
The urgent need to become more inclusive of consumer groups and other partners to promote safety, quality and—yes—health equity has spurred innovation, new initiatives, and newcomers. Nurses who engage with consumer innovators may find themselves with more opportunities to influence policy, by seeking first to understand the consumer point of view, and then to engage on an equal footing through shared partnerships. The following represents a sampling of exciting newer opportunities to engage on behalf of quality and safety.
Patient Family Centered Care Partners
Patient Family Centered Care Partners (PFCCpartners; https://pfccpartners.com) is a small organization with a large vision for improving the quality, safety, and experience of health care through the development of authentic partnerships, from the bedside caregiving relationship to the boardroom where programs and policies are established. It was founded in 2010 in response to a request by the health care community in southern California for a resource and support network to establish patient family‐centered care practice. Its founder is a patient family advisor with more than 20 years’ experience in partnering with hospitals, health care organizations, national health policy organizations, and care teams. This organization is committed to collaborating with patients, families, physicians, health care administrators, nurses, therapists, social workers, and all those invested in improving health care.
Planetree International
Not a newcomer, but certainly one that has established itself in the arena of quality and safety, is Planetree International (https://planetree.org). Integrating the patient and family voice in health care delivery has been at the heart of Planetree’s work since a patient founded it in 1978. Planetree’s health resource center, one of the first of its kind, provided consumers with a broad array of information about quality and safety. It became a model for hundreds of similar centers around the country. Planetree established the country’s first patient‐centered care model, with open medical records, patient‐directed visitation, and attention to spiritual and emotional needs. This model is now used in more than 700 clinical sites in 25 countries and is impacting more than 9 million patients and health care providers globally to view the care journey differently.
As a response to the COVID‐19 pandemic, Planetree took the initiative to develop a document that it promulgated widely: Guidelines for Preserving Family Presence in Challenging Times (Planetree International, 2020). This set of guidelines outlines considerations for maximizing the therapeutic benefits of family presence and participation while in the middle of a response to COVID‐19.
Project Patient Care
Composed of a diverse community of patients, family members of patients, caregivers, health care professionals, and organizational leaders, Project Patient Care (www.projectpatientcare.org) is an independent nonprofit organization working to prevent medical
