Core measures are evidence-based national standard procedures and best practices that were developed to improve the quality of patient care and health outcomes. The Specifications Manual for National Hospital Inpatient Quality Measures was developed by the Centers for Medicare & Medicaid Services (CMS) and the Joint Commission (TJC) to facilitate the data collection process. Core performance measures meeting the criteria proposed by TJC, such as “research, proximity, and accuracy, adverse effects,” may be used for accountability purposes (The Joint Commission, 2021). One of the original accountability measures included in the manual is potentially-preventable venous thromboembolism (VTE-6).
Forster et al. (2012) claim that patient safety and outcomes may be improved via systematic assessment of adverse events (AEs) and risks. VTE-6 is an essential element of hospital accreditation, so it motivates healthcare facilities to enhance their organizational strategies to avoid AEs and achieve desirable outcomes (The Joint Commission, 2020). Specific standards, such as the VTE prophylaxis protocol and collaborative VTE treatment, originated from the measure algorithms designed by the CMS and TJC. As a result, the standards for VTE prophylaxis and treatment helped the providers to successfully assess and manage the cases of hospital-acquired VTE and improve patient compliance and safety.
The primary role of the nurse as a front-line worker is taking care of patients and ensuring their safety to achieve desired clinical outcomes or measurable changes in the patient’s condition. The organization can considerably benefit from its staff’s ability to provide quality service regardless of their emotional state, and the nurse should support the facility’s agenda by providing fair treatment of patients (Laureate Education, 2009). Patient-centered care should be the priority of the organization, the CEO, and nurses because effective strategic agenda development is impossible without collaborative efforts.
The nurse’s compliance/resistance to organizational changes may positively/negatively impact clinical outcomes. However, the strategies designed and approved by the management, executives, and leaders may be insufficient without practical advice and feedback from nurses who regularly communicate with patients and acknowledge the areas for improvement. Amin et al. (2014) state that nursing engagement can reduce readmissions and improve clinical outcomes.
The authors mention two evidence-based projects, Project BOOST and Project RED, as examples of successful patient-centered standardized approaches encouraging nursing advocacy. Therefore, nurses can positively impact clinical outcomes via efforts to provide quality care, respect for the patient’s dignity, involvement in advocacy, and participation in organizational changes.
Nurse-specific challenges can influence change in quality improvement by undermining the nurse’s ability to independently enhance performance or offer meaningful suggestions. Healthcare facilities often focus on financial goals and view patients as customers, so the leadership of such hospitals prioritizes customer service and satisfaction over quality care (Johansen, 2014). As a result of conflicting priorities, nurses may experience frustration and conflict between the organizational agenda and professional competencies, personal values, and ethical principles.
The challenge might undermine the efforts to achieve strategic agenda based on quality care and distract attention from key objectives, such as patient safety, performance indicators, and employee satisfaction. Additionally, organizations may restrict nursing autonomy in the decision-making and instill strict, standardized procedures, so nurses’ abilities to advocate for vulnerable patients, recommend supplemental treatment options, or improve clinical outcomes are limited.
Van Oostveen and Vermeulen (2017) maintain that adequate nurse autonomy is associated with lower patient mortality and better health outcomes. The challenge can disrupt the strategic planning due to the prevalence of high-level management decisions over the feedback from front-line workers who communicate directly with patients and may suggest evidence-based improvements.
Amin, A., Hofmann, H., Owen, M., Hai, T., Tucker, S., & Kaplan, S. (2014). Reduce readmissions with service-based care management. Professional Case Management, 19(6), 255–262. Web.
Forster, A. J., Dervin, G., Martin, C., & Papp, S. (2012). Improving patient safety through the systematic evaluation of patient outcomes. Canadian Journal of Surgery, 55(6), 418–425. Web.
Johansen, M. L. (2014). Conflicting priorities: emergency nurses perceived disconnect between patient satisfaction and the delivery of quality patient care. Journal of Emergency Nursing, 40(1). 13–19. Web.
Laureate Education (Producer). (2009). Topics in clinical nursing: Accountability for clinical outcomes and promoting safety and quality. Author.
The Joint Commission. (2020). Measure information form version 2020A. Specifications manual for Joint Commission national quality measures. Web.
The Joint Commission. (2021). Measures. The Joint Commission Website. Web.
van Oostveen, C., & Vermeulen, H. (2017). Greater nurse autonomy associated with lower mortality and failure to rescue rates. Evidence Based Nursing, 20(2). Web.