Jones & Bartlett Learning Blog

    What Do CQI Leaders Think about the Status of Quality Care?

    Posted by Katie Hennessy on Feb 21, 2017 4:31:56 PM

    Quality ImprovementWelcome back guest blogger, Anita Finkelman, author of Quality Improvement: A Guide for Integration in Nursing, for a new post in the Finding Your Way in Continuous Quality Improvement series.


    On November 11 2016, the Institute for Healthcare Improvement (IHI) published an interview with a video of Donald Berwick, MD, who is one of our experts in quality care. The interview is entitled: To Me, Safety Fatigue Would Be Like Breathing Fatigue or Heart Beat Fatigue.

    This is an important and interesting interview (text and video). I will highlight a few of the comments, however, I recommend sharing this video with your students as it offers the opportunity to hear an honest and direct appraisal of CQI—pluses and minuses. Students could be asked to view individually and summarize their comments, or it could be shown in the classroom followed by open discussion. Dr. Berwick has been a major leader in CQI for many years and for a short time served as Director of the Centers for Medicare and Medicaid Services. He also led the development of the IHI for many years as well. This is a significant time to discuss quality care status with the potential for changes to the ACA due to the new president in office  along with other potential changes that may occur. Some major quality improvement provisions are included in the ACA so one might wonder if they will be impacted, for example, establishment of the first national overall initiative on quality care, the National Quality Strategy, and the Patient-Outcomes Research Institute (PCORI). It's imperative that are alert to changes, but also ask where are we now?

    Below are a few key points which I’ve outlined from Dr. Berwick’s interview. Note that there is much more content found within the actual interview and it’s well worth carving out some time to  listen.

    • Patient safety fatigue has become a problem. Just keep going from one CQI project to the next, with little systematic thought. The focus is on getting it done to move on.
    • We need to build systems of safety.
    • We focused first on hospital care (for example, the original Institute of Medicine reports focused only on hospital care with two reports on public heath—though mostly examining education needs of healthcare professionals in public health). Now we need to expand to other types of settings—across the care continuum.
    • “The EHR (EMR) story is a good news, bad news story if I have ever heard one.”
    • We need to practice informed anticipation.

    About the text:

    Quality Improvement: A Guide for Integration in Nursing serves as a comprehensive resource for teaching practicing nurses and nursing students about the importance of improving patient care and reducing errors through quality improvement.  The text focuses on the practical aspects of quality improvement and the nurse’s role in the process, while acknowledging the importance of an inter-professional approach.  In addition, it focuses on the current state of healthcare quality in the US, critical trends in preventing errors, data, analysis, and planning and implementing change to reach improvement. The author connects quality improvement to technology and the role of the patient while emphasizing the importance of engagement and nursing leadership. Learn more at our website.

    Topics: Anita Finkelman, nursing, quality improvement

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