in Textbox 2.3.
As part of the IHI initiative, it released two supplementary resources to provide detailed guidance: a Self‐Assessment Tool to assist leaders and organizations in deciding where to start, and an Implementation Resource Guide detailing tactics and supporting resources for implementing the National Action Plan recommendations (http://www.ihi.org/Engage/Initiatives/National‐Steering‐Committee‐Patient‐Safety/Pages/default.aspx).
Textbox 2.2 Safer Together: A National Action Plan to Advance Patient Safety
The National Action Plan's four foundational and interdependent areas:
Culture, leadership, and governance: The imperative for leaders, governance bodies, and policy‐makers to demonstrate and foster our deeply held professional commitments to safety as a core value and promote the development of cultures of safety.
Patient and family engagement: The spread of authentic patient and family engagement; the practice of co‐designing and co‐producing care with patients, families, and care partners to ensure their meaningful partnership in all aspects of care design, delivery, and operations.
Workforce safety: Ensuring the safety and resiliency of the organization and the workforce is a necessary precondition to advancing patient safety; we need to work toward a unified, total systems‐based perspective and approach to eliminate harm to both patients and the workforce.
Learning system: Establishing networked and continuous learning; forging learning systems within and across health care organizations at the local, regional, and national levels to encourage widespread sharing, learning, and improvement (Institute for Healthcare Improvement, 2020).
Textbox 2.3 Institute for Healthcare Improvement National Action Plan Cross‐Cutting Themes
Person‐centered care: Patients, families, and care partners experience lifelong care journeys across the entire continuum of care. They have a unique and essential perspective on care delivery, and their insights on “what matters” are critical for creating safer care.
Care across the entire continuum: Care is provided in locations outside of hospitals, including ambulatory, long‐term care facilities, home, and other community‐based settings. The recommendations in the National Action Plan are meant to be relevant to all settings across the care continuum.
The relationship between patient safety and health equity: Health inequities are “linked to the complicated history and reality of racism, classism, sexism, ableism, ageism, and other forms of oppression.” Inequities result in a concentration of harm in specific population groups, based on characteristics such as race, ethnicity, sexual orientation, gender, age, disability, and income, and must be considered when designing safety efforts to ensure that inequities are being addressed.
Informatics, Electronic Health Records, and Impact of Technology on Quality and Policy
While also helping align the health care industry with quality expectations in other industries, dialogue about the use of technology, nursing terminologies, and consistent specifications for data capture, including physician order entry, diagnoses, interventions, and decision support, became part of the quality discussion. Harnessing complex technology for quality improvement and reporting purposes has become crucial.
Data collection burdens, the accuracy of electronic data extractions, the timeliness of data reporting and analysis, the ability to have timely comparisons to benchmarks—all of these impact not only the performance improvement process, but also the ability to ensure that patients are receiving the care they deserve within a safety culture. This was particularly relevant during the COVID‐19 pandemic, when nurse staffing was at a crisis level due to tremendous patient loads. Further, most electronic health record systems do not collect meaningful data that would allow sufficient analysis about social determinants of health, often leading to inequitable care delivery.
The challenge of many electronic systems is that while many data go into the system, particularly in the delivery of nursing care, it can be nearly impossible to extract them for reporting and analysis. Further, decision supports based on data that identify a patient with a stage‐two pressure ulcer, for instance, must also incorporate, in a timely way from the patient perspective, an evidence‐based, appropriate plan of action to both prevent further skin breakdown and begin healing. From a public reporting perspective, is it enough to know that a patient is at risk of experiencing a pressure sore while hospitalized? Engaged consumers and insurers will want to know what the data show about not only the prevention of decubiti, but also the appropriateness of treatment, the speediness of recovery, lost work days, and impact on the quality of life. Policy‐makers are interested in lengths of stay and other factors that drive up the cost of such hospital‐acquired conditions.
Nursing continues to drive forward in the development of electronic measures (eMeasures), particularly data collection on the incidence of pressure ulcers. As of yet, no pressure ulcer eMeasure has been endorsed by NQF, nor is there national‐level public reporting of any nursing measures.
Nursing informatics and the use of nursing terminologies are central to capturing key data elements in a consistent way. Adherence to consensus‐based terminologies, both for the collection of data around the nursing‐sensitive measures but also the processes of care, is necessary to articulate the actual contributions of nurses, their importance in keeping patients safe, and improving the quality of care, as identified in both the IOM reports and the QSEN competencies (Cronenwett et al., 2007, 2009).
A major contributor to this agenda was the Technology Informatics Guiding Education Reform (TIGER) initiative, launched as a result of a 2006 conference convened to create a vision for the future of nursing, bridging the quality chasm with IT, enabling nurses to use informatics in practice and education to provide safer, high‐quality patient care. The development and implementation of the TIGER initiative are described in Chapter 9. Although the EU*US eHealth Work Project has ended, TIGER is currently compiling global case studies to continue bringing the work to life, with a focus on all states within the EU (https://www.himss.org/tiger‐initiative‐international‐competency‐synthesis‐project).
Quality Alliances Influence Policy Actions through a Professional Lens
Various professions have followed a model similar to that of NQF while determining their own efforts to influence the measurement of quality, support quality improvements, and take action at a national policy level. From a positive perspective, these alliances create a pipeline for their profession’s or specialty’s representation at national stakeholder tables, for grooming nominees with the expertise to inform measure development and policy setting, and for providing national leadership for the overall quality agenda. Each faces similar challenges, including that of determining membership and governance structures and dues for long‐term financial sustainability. Each needs to coordinate with other stakeholders and standard setters among its own discipline in order to lead with one voice. Externally, each alliance forms a coherent, coordinated, and consistent approach to quality and measurement that moves the health care system forward as a whole, without becoming
