quality improvement essay sample

150+ Quality Improvement Ideas and Topics for QI Project Paper [Guide & Examples]

Quality improvement ideas and topics for qi project paper.

In nursing, Quality Improvement (QI), also known as Continuous Quality Improvement (CQI) initiatives, is critical in improving and enhancing patient care. The guide below will help you craft a structured quality improvement paper (QI Research Paper) based on well-researched quality improvement ideas, topics, areas, and issues.

What is Quality Improvement? 

In Nursing, quality improvement provides a systematic framework for evaluating, enhancing, and improving care. 

The four steps of nursing quality improvement projects include; 

• Identifying the nursing practice problem, such as patient falls or medication errors
• Collecting data on the problem to determine critical indicators such as incidence rates. The quality of the data collected determines the effectiveness of the research and quality initiative. 
• Develop and implement an intervention that addresses the problem and can contribute to continuous quality improvement. 
• Evaluate the results and determine the effectiveness of the quality improvement initiative. 

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Importance of Quality Improvement

• It helps an organization’s internal systems and processes to improve outcomes and provide safer, cost-effective, and efficient patient health care.
• CQI implementation requires ethical oversight due to the various ethical issues associated with the process. 
• The CQI implementation should meet the following requirements: social or scientific value, scientific validity, fair subject selection, favorable risk-benefit ratio, informed consent, respect for participants, and independent review.

How do you choose a quality improvement project area?

• Technical Merit – explore areas that provide the most value for patients, nurses, and other practitioners within the organization
• Conduct a root cause analysis to determine the critical areas for improvement such as safety and quality
• Evaluate the community and population to determine any potential areas to improve health care quality. This includes examining issues to do with patient experiences such as barriers to care, conditions, or groups of high-risk patients within the patient population. 
• You can also rely on personal experience of patient care, or observation.
• An audit of a critical incident, organizational process, evidence review, or patient feedback such as complaints, compliments, and discussions. 

Methods of conducting the quality improvement process 

1. Plan Do Study Act (PDSA)  is an interactive, iterative, and four-step quality improvement method. It perceives the process, assesses it further, revises it appropriately, and repeats the cycle for sustained improvement (Knudsen et al., 2019). 

• Under the planning stage, the quality improvement team identifies a problem, analyzes it, clarifies goals and objectives, defines success, identifies critical team players, and selects strategies to put the plan into action.
• In the Do stage, the plan’s components are implemented. The stage involves implementing the action plan, collecting data, designing appropriate tools to conduct changes, and performing appropriate change activities.
• The Study stage entails monitoring outcomes and testing the validity of the activities against goals and objectives. The team analyzes the gathered data, ensures the plan is working, and identifies and removes bottlenecks.
• The final stage, Act, is the end of the cycle and involves integrating and learning from insights generated by the entire process.

2. Six Sigma is a quality improvement method widely used to improve processes and performance in the healthcare industry.

• The method eliminates defects and waste, resulting in improved quality and efficiency. It streamlines and improves all healthcare processes.
• Six Sigma identifies defects in a process and indicates the percentage of defect-free processes.
• It employs the DMAIC methodology that involves defining, measuring, analyzing, improving, and controlling quality problems in healthcare processes. 

How to write up a QI project Paper

QI Project Papers or Research papers are often guided by marking rubrics and set instructions on addressing each section of the project.   SQUIRE guidelines provide a framework useful in quality improvement reporting. 

Title Page  

• Includes the name of the quality improvement initiative and any other identifying information, such as the implementation facility and your name. It should be 50 words in length.
• Summarize all the critical information in the various sections of the report. 
• The structure should include background , local problem , methods , interventions , results , and conclusion . 

Introduction

The introduction answers the question of why and where. The components of the introduction include; 

• Problem description, which includes the QI Problem Statement. The problem statement should indicate the nature and significance of the problem within the organization.
• Summary of available information and knowledge on the problem, including the empirical studies conducted on the problem in other organizations. This should also highlight contributing factors and barriers.
• Provide a rationale for the problem. This includes using models, frameworks, concepts, and theories to examine the problem.
• Outline any assumptions used in the development of the interventions and reasons why the project will be successful.
• State the specific aims and purpose of the project and the report

The methods section provides a guide on what measures, strategies, and analysis were used to develop the intervention and during implementation. 

• Provide contextual elements to introduce the intervention and the local problem.
• Describe and elaborate on the intervention to ensure others can replicate or reproduce it. Also, provide precise specifics on the team involved in the design and implementation of the intervention. 
• – state the approach used to determine the effect of the intervention
• – state the measures used to establish if the measured outcomes were as a result of the intervention
• – discuss the measures selected for studying the intervention’s processes and outcomes by stating the rationale for selecting the measures, operational definitions, validity, and reliability. 
• – describe the evaluation measures and elements that led to the effectiveness of the measure
•  – state and provide a rationale for the method used to determine the completeness and accuracy of data. 
• – You can use either qualitative or quantitative methods of analysis
• -define the methods useful in determining variations in the data and the effects of time as a variable
• Describe the ethical aspects of the project and intervention and how they were addressed.

Results 

When writing the results section of the QI, 

• Start the results section by outlining the initial steps of the intervention and it’s change over time. Visual/statistical representations such as flow charts or tables effectively present results. 
• Provide extensive details of the process measures and outcomes
• Define the contextual parts that interacted with the intervention during the implementation stage
• Report on the observed connections between the outcome and intervention, as well as other relevant issues that occur during the project
• Report on the unintended results of the implementation process, such as unexpected benefits, problems, failures, or costs 
• Include a section on any missing data

Discussion 

The discussion section provides a summary and interpretation of the key findings and highlights the project’s limitations. The last part of the discussion section concludes the project by describing the usefulness, sustainability, and implications of the project in practice. 

When working on the discussion section, 

• Provide a summary of the key findings and how they are related to the rationale and specific aims, and also summarize the strengths of the project
• – makes a comparison between the results and findings from empirical studies 
• – Describe the project’s impact on people (patients and staff), the organization, and the systems. 
• – Describe any reasons for any differences between expected results and actual findings 
• – define any opportunity costs 
• Highlight the limits to the generalizability of the work and any measures taken to minimize the effect of limitations.
• Provide a clear conclusion to the QI project highlighting usefulness, sustainability, use in other fields, implications of the project on practice, and any suggested next steps. 

Nursing Quality Improvement Ideas, Topics, Issues and Areas

10 examples of nursing quality improvement issues.

The common quality improvement issues include;

• Workflow Redesign to Reduce the Time Interval Between Patient Check-In and First Needle Stick for Ultrasound-Guided Thyroid Fine Needle Aspirations
• Utilizing Clinical Resources to Reduce Clinical Messages
• Improving the Transfer Process In The MICU
• The Patient Satisfaction Experience: Enhancing Bedside Shift Report
• Structured Family Meetings in the Medical ICU at Emory University Hospital
• Revenue Cycle Improvement – Decrease Days in Accounts Receivables
• Reduction of Urosepsis as a Cause for 30-Day Hospital Readmissions in Radical Cystectomy Patients
• Reduction of Catheter-Associated Urinary Tract Infections, a Team Approach
• Reduction in Ventilator-Associated Pneumonia
• Reducing the Rate of “Nonclassifiable” PCI Procedures for Appropriate Use Criteria Reporting in Two Teaching Hospitals

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30 Practical Topics for Your QI Paper

• Reducing Post-Operative Urinary Tract Infections: Implementation of a Nurse-driven CAUTI Protocol on 10E
• Reducing Mechanical Restraint in an Acute Behavioral Health Setting
• Reducing Inappropriate Blood Transfusions
• Reducing Imaging Exam Order-to-Start Turnaround Time for ED Patients at EUH
• Reducing Idle Room Time at Winship Clinic
• Reducing Door to Antibiotic Administration Time in Suspected Sepsis
• Reducing Central Line Infections in 11 ICU
• Reducing Breast MRI No-Shows
• Reduce Errors in Height and Weight Assessment and Documentation for Winship Cancer Institute
• Radiology Report Attestations
• Quality Project to Reduce Absenteeism at the Transitions Senior Program
• Psychiatric Patients in the ED – Wording of the Safety Hold Order
• Provider Billing & Schedule Link Improvement Project
• Prevention of Contaminated Blood Cultures: Protecting Patients from Additional Interventions
• Preoperative Beta Blocker Administration Quality Improvement Initiative
• Please Release Me: A Restraint Reduction Initiative
• Patients who Leave the PACU with a Urinary Catheter and No Order
• Patient Cycle Time Laboratory Building A
• Patient – Practice Communications, Department of Neurology
• Partial Hospitalization Program Geriatric Depression Scale Compliance
• Orthopaedics Charge Capture Improvement
• Oral Care with Chlorhexidine Gluconate: Does it Reduce VAP rates?
• Ontime Starts Chemotherapy
• Omnicell Reconciliation
• Notification of Waits and Delays to Patients
• No Patient Left Behind, Real Time SCIP Data Collection
• Medication Coverage at Discharge
• Medicare Rights Notification Compliance
• IR On Time Start

20 Quality improvement ideas for nursing students

• Internal Medicine (TEC A4) Check-out Waits & Delays
• Intentional Bathroom Breaks as a Fall Reduction Strategy
• Increasing the Rate of Tdap Vaccination Offering to Patients in a Resident Run Urban Community Primary Care Clinic
• Increase Mobilization of Surgical Patients
• Improving the Recognition and Assessment of Obesity In the Resident Primary Care Clinic
• Improving the Rates of Patients Bringing their Medications to the Clinic: the Show-Your-Medications (SYM) Project
• Improving the Rate of Response to Safety Events in Radiology
• Improving the Rate of HIV Testing in Eligible Clinic Patients: Implementation of a Dot Phrase and Template Change in EMR
• Improving the Clinic Visit Summary Process in General Internal Medicine at MOT
• Improving Social Services Consult Compliance Rate for Stroke Patients
• Improving Safety through Updating Medication Lists in Sports Medicine
• Improving Radiology Final Report Turn Around Time for After Hours Emergency Department Imaging Exams at EUH and EUHM
• Improving Quality Scores Of Hypertensive Patients At Dunwoody
• Improving Provider Communication: Transplant’s Lung Program
• Improving Provider Communication: Inpatient Correspondence Center Utilization
• Improving Pneumonia Vaccine Screening
• Improving Pneumonia Quality Measures in the Emergency Department
• Improving Percentage of Patients with Self-Management Goals in Emory Patient Centered Primary Care
• Compliance with Intentional Rounding Tool (IR)
• Chairside Checkout in Medical Oncology Building C
• CCU CLABSI Prevention: CHG Bath Project.

24 Topics for Quality Improvement Research Paper

• Improving Admission Medication Reconciliation Rates on a Hospital Medicine Unit of a Large Academic Medical Center: An Official Sounding Study
• Improve Patient Access: Emory at Smyrna & Emory at Eagles Landing
• Implementation of POD Teams in the EUHM Emergency Department
• Implementation of an Electronic MRI Scanner QA Log Using RedCap
• Implementation of a Falls Reductions Program in an Acute Care Setting
• HTN-2: Blood Pressure Control
• Newborn Hepatitis B Vaccination QI Project: Delivery Before 12 hours of life
• Improving Newborn Hepatitis B Vaccination
• Hand Hygiene Compliance in a Hemodialysis Unit
• Guest Services: Patient Transporters
• Front Desk Arrival Time SMG-Vascular Surgery
• Fix The Phones
• EUHM Pre-Admission Testing Reducing Patient Wait Times
• ER Patient Exam Delay
• Drug Purchasing Based on Utilization: A Formula for High Margins
• Document Control of the Prospective Reimbursement Analysis (PRA)
• Discharge Order + Instruction Improvement Project
• Diagnostic Ultrasound: QI Project to Standardize Exams Across Emory Healthcare
• Diabetic Ketoacidosis Protocol
• Development of the Emory Healthcare Bedside Shift Report Bundle and the Effect on Patient Satisfaction
• Impact of quality improvement initiatives on patient care
• Quality improvement program outcomes in various settings
• Quality improvement efforts in addressing medical errors
• Implementing Quality Improvement in Healthcare Settings

25 Quality Improvement Areas 

• Advocacy for vulnerable population
• Death and dying, hospice care, palliative care
• Hospital without walls
• Nursing centers
• Home care issues
• Therapeutic Touch and other health patterning modalities (imagery, relaxation, music, therapy, light therapy, aromatherapy)
• Pain control management in specific populations
• Fall injury prevention
• Social support
• Family caregiver
• Coping with chronic illness
• Prevention/treatment of heart disease, cancer, etc., through nutritional approaches (diet, vitamins, minerals, herbs)
• Leadership issues
• Restructuring the work environment
• Power enhancement
• Violence toward women/populations at risk/nurses
• Elder/child spouse abuse
• Post-traumatic stress response/management
• Role restructuring
• Advance directives
• Alternatives to restraints
• Palliative Care

13 Examples of Quality Improvement Projects in Overall Patient Care

• Improving Patient Satisfaction in the Patient Centered Medical Home
• Improving Patient Outcomes Through Inpatient Psychiatric Core Measures
• Improving Nutrition Delivery for Mechanically Ventilated Patients Receiving Enteral Nutrition
• Improving Medication Reconciliation in a Resident Primary Care Clinic
• Improving Inpatient Charge Capture (Professional Fees)
• Improving Hypertension Control in the Patient Centered Medical Home
• Improving Hypertension Control at Emory Patient-Centered Primary Care (PCPC)
• Improving Hepatitis C Screening in a Primary Care Internal Medicine Resident Clinic
• Improving EUHM Radiology Interdepartmental Patient Hand Offs
• Improving Counseling for Tobacco Cessation in a Resident Primary Care Clinic
• Improving Continuity of Care: Establishing Primary Care Physician-Patient Relationships in a Resident Clinic
• Improving Cardiology OP SCIP Compliance Rate at EUH & EUHM.
• Improving Blood Glucose Control in the Cardiothoracic Surgery Patient Population

8 Examples Of Quality Improvement Initiatives In Healthcare & Hospitals

• CAUTI Prevention Team
• Care Initiation’s Patient Transfer Times
• Care Initiation Rounds and Interdisciplinary Communication
• Budd Terrace Skilled Nursing Facility Readmissions Pilot
• Atlanta Community-based Care Transitions Program (CCTP)
• Antibiotic Stewardship: Reducing Quinolone Use in the Hospital
• Antibiotic Protocol in EJCH ED Sepsis Patients
• Advanced Health Care Directive Education in the Primary Care Setting
• Achieving 100% Documentation of the Pre-operative Checklist Beta Blocker Section
• Addressing Medical Errors through Quality Improvement
• Enhancing Quality of Care in Healthcare Settings

5 Examples of Quality Improvement Projects

• Reducing Medication Errors Quality Improvement Project
• Quality Improvement Initiative for Pedophilic Disorder
• Implementation of TQM in Nursing Care
• Quality Improvement and Patient Safety Practicum
• I ntimate Partner Violence Practicum Evaluation

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How to improve healthcare improvement—an essay by Mary Dixon-Woods

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Quality Improvement

Collection date 2019.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

As improvement practice and research begin to come of age, Mary Dixon-Woods considers the key areas that need attention if we are to reap their benefits

In the NHS, as in health systems worldwide, patients are exposed to risks of avoidable harm 1 and unwarranted variations in quality. 2 3 4 But too often, problems in the quality and safety of healthcare are merely described, even “admired,” 5 rather than fixed; the effort invested in collecting information (which is essential) is not matched by effort in making improvement. The National Confidential Enquiry into Patient Outcome and Death, for example, has raised many of the same concerns in report after report. 6 Catastrophic degradations of organisations and units have recurred throughout the history of the NHS, with depressingly similar features each time. 7 8 9

More resources are clearly necessary to tackle many of these problems. There is no dispute about the preconditions for high quality, safe care: funding, staff, training, buildings, equipment, and other infrastructure. But quality health services depend not just on structures but on processes. 10 Optimising the use of available resources requires continuous improvement of healthcare processes and systems. 5

The NHS has seen many attempts to stimulate organisations to improve using incentive schemes, ranging from pay for performance (the Quality and Outcomes Framework in primary care, for example) to public reporting (such as annual quality accounts). They have had mixed results, and many have had unintended consequences. 11 12 Wanting to improve is not the same as knowing how to do it.

In response, attention has increasingly turned to a set of approaches known as quality improvement (QI). Though a definition of exactly what counts as a QI approach has escaped consensus, QI is often identified with a set of techniques adapted from industrial settings. They include the US Institute for Healthcare Improvement’s Model for Improvement, which, among other things, combines measurement with tests of small change (plan-do-study-act cycles). 8 Other popular approaches include Lean and Six Sigma. QI can also involve specific interventions intended to improve processes and systems, ranging from checklists and “care bundles” of interventions (a set of evidence based practices intended to be done consistently) through to medicines reconciliation and clinical pathways.

QI has been advocated in healthcare for over 30 years 13 ; policies emphasise the need for QI and QI practice is mandated for many healthcare professionals (including junior doctors). Yet the question, “Does quality improvement actually improve quality?” remains surprisingly difficult to answer. 14 The evidence for the benefits of QI is mixed 14 and generally of poor quality. It is important to resolve this unsatisfactory situation. That will require doing more to bring together the practice and the study of improvement, using research to improve improvement, and thinking beyond effectiveness when considering the study and practice of improvement.

Uniting practice and study

The practice and study of improvement need closer integration. Though QI programmes and interventions may be just as consequential for patient wellbeing as drugs, devices, and other biomedical interventions, research about improvement has often been seen as unnecessary or discretionary, 15 16 particularly by some of its more ardent advocates. This is partly because the challenges faced are urgent, and the solutions seem obvious, so just getting on with it seems the right thing to do.

But, as in many other areas of human activity, QI is pervaded by optimism bias. It is particularly affected by the “lovely baby” syndrome, which happens when formal evaluation is eschewed because something looks so good that it is assumed it must work. Five systematic reviews (published 2010-16) reporting on evaluations of Lean and Six Sigma did not identify a single randomised controlled trial. 17 18 19 20 21 A systematic review of redesigning care processes identified no randomised trials. 22 A systematic review of the application of plan-do-study-act in healthcare identified no randomised trials. 23 A systematic review of several QI methods in surgery identified just one randomised trial. 56

The sobering reality is that some well intentioned, initially plausible improvement efforts fail when subjected to more rigorous evaluation. 24 For instance, a controlled study of a large, well resourced programme that supported a group of NHS hospitals to implement the IHI’s Model for Improvement found no differences in the rate of improvement between participating and control organisations. 25 26 Specific interventions may, similarly, not survive the rigours of systematic testing. An example is a programme to reduce hospital admissions from nursing homes that showed promise in a small study in the US, 27 but a later randomised implementation trial found no effect on admissions or emergency department attendances. 28

Some interventions are probably just not worth the effort and opportunity cost: having nurses wear “do not disturb” tabards during drug rounds, is one example. 29 And some QI efforts, perversely, may cause harm—as happened when a multicomponent intervention was found to be associated with an increase rather than a decrease in surgical site infections. 30

Producing sound evidence for the effectiveness of improvement interventions and programmes is likely to require a multipronged approach. More large scale trials and other rigorous studies, with embedded qualitative inquiry, should be a priority for research funders.

Not every study of improvement needs to be a randomised trial. One valuable but underused strategy involves wrapping evaluation around initiatives that are happening anyway, especially when it is possible to take advantage of natural experiments or design roll-outs. 31 Evaluation of the reorganisation of stroke care in London and Manchester 32 and the study of the Matching Michigan programme to reduce central line infections are good examples. 33 34

It would be impossible to externally evaluate every QI project. Critically important therefore will be increasing the rigour with which QI efforts evaluate themselves, as shown by a recent study of an attempt to improve care of frail older people using a “hospital at home” approach in southwest England. 35 This ingeniously designed study found no effect on outcomes and also showed that context matters.

Despite the potential value of high quality evaluation, QI reports are often weak, 18 with, for example, interventions so poorly reported that reproducibility is frustrated. 36 Recent reporting guidelines may help, 37 but some problems are not straightforward to resolve. In particular, current structures for governance and publishing research are not always well suited to QI, including situations where researchers study programmes they have not themselves initiated. Systematic learning from QI needs to improve, which may require fresh thinking about how best to align the goals of practice and study, and to reconcile the needs of different stakeholders. 38

Using research to improve improvement

Research can help to support the practice of improvement in many ways other than evaluation of its effectiveness. One important role lies in creating assets that can be used to improve practice, such as ways to visualise data, analytical methods, and validated measures that assess the aspects of care that most matter to patients and staff. This kind of work could, for example, help to reduce the current vast number of quality measures—there are more than 1200 indicators of structure and process in perioperative care alone. 39

The study of improvement can also identify how improvement practice can get better. For instance, it has become clear that fidelity to the basic principles of improvement methods is a major problem: plan-do-study-act cycles are crucial to many improvement approaches, yet only 20% of the projects that report using the technique have done so properly. 23 Research has also identified problems in measurement—teams trying to do improvement may struggle with definitions, data collection, and interpretation 40 —indicating that this too requires more investment.

Improvement research is particularly important to help cumulate, synthesise, and scale learning so that practice can move forward without reinventing solutions that already exist or reintroducing things that do not work. Such theorising can be highly practical, 41 helping to clarify the mechanisms through which interventions are likely to work, supporting the optimisation of those interventions, and identifying their most appropriate targets. 42

Research can systematise learning from “positive deviance,” approaches that examine individuals, teams, or organisations that show exceptionally good performance. 43 Positive deviance can be used to identify successful designs for clinical processes that other organisations can apply. 44

Crucially, positive deviance can also help to characterise the features of high performing contexts and ensure that the right lessons are learnt. For example, a distinguishing feature of many high performing organisations, including many currently rated as outstanding by the Care Quality Commission, is that they use structured methods of continuous quality improvement. But studies of high performing settings, such as the Southmead maternity unit in Bristol, indicate that although continuous improvement is key to their success, a specific branded improvement method is not necessary. 45 This and other work shows that not all improvement needs to involve a well defined QI intervention, and not everything requires a discrete project with formal plan-do-study-act cycles.

More broadly, research has shown that QI is just one contributor to improving quality and safety. Organisations in many industries display similar variations to healthcare organisations, including large and persistent differences in performance and productivity between seemingly similar enterprises. 46 Important work, some of it experimental, is beginning to show that it is the quality of their management practices that distinguishes them. 47 These practices include continuous quality improvement as well as skills training, human resources, and operational management, for example. QI without the right contextual support is likely to have limited impact.

Beyond effectiveness

Important as they are, evaluations of the approaches and interventions in individual improvement programmes cannot answer every pertinent question about improvement. 48 Other key questions concern the values and assumptions intrinsic to QI.

Consider the “product dominant” logic in many healthcare improvement efforts, which assumes that one party makes a product and conveys it to a consumer. 49 Paul Batalden, one of the early pioneers of QI in healthcare, proposes that we need instead a “service dominant” logic, which assumes that health is co-produced with patients. 49

More broadly, we must interrogate how problems of quality and safety are identified, defined, and selected for attention by whom, through which power structures, and with what consequences. Why, for instance, is so much attention given to individual professional behaviour when systems are likely to be a more productive focus? 50 Why have quality and safety in mental illness and learning disability received less attention in practice, policy, and research 51 despite high morbidity and mortality and evidence of both serious harm and failures of organisational learning? The concern extends to why the topic of social inequities in healthcare improvement has remained so muted 52 and to the choice of subjects for study. Why is it, for example, that interventions like education and training, which have important roles in quality and safety and are undertaken at vast scale, are often treated as undeserving of evaluation or research?

How QI is organised institutionally also demands attention. It is often conducted as a highly local, almost artisan activity, with each organisation painstakingly working out its own solution for each problem. Much improvement work is conducted by professionals in training, often in the form of small, time limited projects conducted for accreditation. But working in this isolated way means a lack of critical mass to support the right kinds of expertise, such as the technical skill in human factors or ergonomics necessary to engineer a process or devise a safety solution. Having hundreds of organisations all trying to do their own thing also means much waste, and the absence of harmonisation across basic processes introduces inefficiencies and risks. 14

A better approach to the interorganisational nature of health service provision requires solving the “problem of many hands.” 53 We need ways to agree which kinds of sector-wide challenges need standardisation and interoperability; which solutions can be left to local customisation at implementation; and which should be developed entirely locally. 14 Better development of solutions and interventions is likely to require more use of prototyping, modelling and simulation, and testing in different scenarios and under different conditions, 14 ideally through coordinated, large scale efforts that incorporate high quality evaluation.

Finally, an approach that goes beyond effectiveness can also help in recognising the essential role of the professions in healthcare improvement. The past half century has seen a dramatic redefining of the role and status of the healthcare professions in health systems 54 : unprecedented external accountability, oversight, and surveillance are now the norm. But policy makers would do well to recognise how much more can be achieved through professional coalitions of the willing than through too many imposed, compliance focused diktats. Research is now showing how the professions can be hugely important institutional forces for good. 54 55 In particular, the professions have a unique and invaluable role in working as advocates for improvement, creating alliances with patients, providing training and education, contributing expertise and wisdom, coordinating improvement efforts, and giving political voice for problems that need to be solved at system level (such as, for example, equipment design).

Improvement efforts are critical to securing the future of the NHS. But they need an evidence base. Without sound evaluation, patients may be deprived of benefit, resources and energy may be wasted on ineffective QI interventions or on interventions that distribute risks unfairly, and organisations are left unable to make good decisions about trade-offs given their many competing priorities. The study of improvement has an important role in developing an evidence-base and in exploring questions beyond effectiveness alone, and in particular showing the need to establish improvement as a collective endeavour that can benefit from professional leadership.

Mary Dixon-Woods is the Health Foundation professor of healthcare improvement studies and director of The Healthcare Improvement Studies (THIS) Institute at the University of Cambridge, funded by the Health Foundation. Co-editor-in-chief of BMJ Quality and Safety , she is an honorary fellow of the Royal College of General Practitioners and the Royal College of Physicians. This article is based largely on the Harveian oration she gave at the RCP on 18 October 2018, in the year of the college’s 500th anniversary. The oration is available here: http://www.clinmed.rcpjournal.org/content/19/1/47 and the video version here: https://www.rcplondon.ac.uk/events/harveian-oration-and-dinner-2018

This article is one of a series commissioned by The BMJ based on ideas generated by a joint editorial group with members from the Health Foundation and The BMJ , including a patient/carer. The BMJ retained full editorial control over external peer review, editing, and publication. Open access fees and The BMJ ’s quality improvement editor post are funded by the Health Foundation.

Competing interests: I have read and understood BMJ policy on declaration of interests and a statement is available here: https://www.bmj.com/about-bmj/advisory-panels/editorial-advisory-board/mary-dixonwoods

Provenance and peer review: Commissioned; not externally peer reviewed.

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Quality Improvement Essay Samples

Type of paper: Essay

Topic: Nursing , Quality , Improvement , Health , Activities , Care , Nurses , Medicine

Published: 05/23/2023

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Quality improvement refers to the process aimed at improving the overall performance of the health care sector. A continuous process aims at attaining quality improvement in the provision of health care services that suit the specific needs of the patients. The paper discusses the activities involved in the quality improvement, the roles of professional nurses in the activities, factors affecting nursing participation as well as strategies that can be used to improve the overall care. Different health practices have an established strategic plan for carrying out the improvements that are considered essential in the clinical setup. The quality improvement activities can be classified in various forms such as changes in the daily activities of practice. The day-to-day activities that may need improvement may include the normal opening hours, changing the way patients’ complaints are handled, proper scheduling of appointments and improving health records keeping. Additionally, the practices may change the system to avoid future complications in the scheduling of appointments. Other quality improvements by the health care include activities aimed at improving the care for the entire patient population in the clinics (Draper et al., 2008). Such activities may include improving the immunization rates as well as improving care for patients with long-term conditions such as diabetes and hypertension. It also includes changing the systems to make them effective in measuring the risk of prevalence of certain conditions among the people living in the community. As such, the clinics undertake internal assessments of the handover processes through examining the referral recipients to determine whether the processes are satisfactory and effective among the people or not. As the hospitals continue to face a demand for quality improvement, the roles of the nurses have also evolved. The roles of the nurses are identified in researches done by the center for studying health systems change (McHugh & Stimpfel, 2012). Nurses are pivotal in ensuring that health care improvement has been attained. Therefore, as the hospitals engage in a wide range of quality improvement activities, they heavily rely on the nurses to assist in addressing the demands. Professional nurses have the responsibility of providing the hospital with the right information on how the organization can maximize the resources to improve patient care quality. Various factors or challenges limit the nurses’ involvement in the health care quality improvement. Such factors include the scarcity of nurses that forces the hospital to hire part-time staffs (Kuehn, 2007). Engaging nurses from the bedside activities to managerial roles sometimes confuses or sends mixed messages on their roles in the quality improvement process (Draper et al., 2008). It limits their abilities to be engaged in other activities of the organization that are considered essential for quality improvement. The demands for more participation in activities that promote quality improvement is growing. Lastly, the challenges associated with confronting the old nursing education may not prepare nurses for future developing roles in the modern-day clinical settings. Quality improvement requires the establishment of a supportive leadership that is active and engages all the stakeholders of the organization. A strong leadership supports the activities of quality improvement since it makes the decisions for the organization. It is also necessary to set up expectations for all the staffs since quality improvement is a shared responsibility thereby implying that all staffs should be allowed to participate in IQ. Encouraging individual responsibilities equips an employee with skills that help in the promotion of accountability for patient safety and quality (Kuehn, 2007). The hospital will need to provide a two-way feedback mechanism that will help the organization to obtain the required information. Obtaining feedback is essential for the firm since it allows the management to make good decisions for further improvement based on the feedback obtained from various stakeholders from the community or local levels. Various methods such as staff training, newsletters, electronic communication and staff meetings can be used to provide quality improvement feedbacks. During the assignment of duties or recruitment, it is necessary to choose the best candidates, who can create accountable staffs (Draper et al., 2008). Promoting as well as identifying nurses and other physicians empowers their efforts in the improvement of health care. As such, the employees to champion and engage in activities or incentives aimed at improving the quality of care. The issue of health care quality improvement has become a national agenda to improve the sector. However, the increased demand has come when the economic settings have resulted in reduced resources thereby limiting the attainment of the objectives (McHugh & Stimpfel, 2012). Quality improvement requires a firm to engage in activities that contribute to the overall improvement. However, various factors limit the success thereby demonstrating the need to establish a working plan or strategies that will help in the improvement of quality.

McHugh, M. D., & Stimpfel, A. W. (2012). Nurse reported quality of care: a measure of hospital quality. Research in nursing & health, 35(6), 566-575. Draper, D. A., Felland, L. E., Liebhaber, A., & Melichar, L. (2008). The role of nurses in hospital quality improvement. Research brief, (3), 1-8. Kuehn, B. M. (2007). No end in sight to nursing shortage. JAMA, 298(14), 1623-1625.

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Quality improvement into practice

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• Peer review
• Adam Backhouse , quality improvement programme lead 1 ,
• Fatai Ogunlayi , public health specialty registrar 2
• 1 North London Partners in Health and Care, Islington CCG, London N1 1TH, UK
• 2 Institute of Applied Health Research, Public Health, University of Birmingham, B15 2TT, UK
• Correspondence to: A Backhouse adam.backhouse{at}nhs.net

What you need to know

Thinking of quality improvement (QI) as a principle-based approach to change provides greater clarity about ( a ) the contribution QI offers to staff and patients, ( b ) how to differentiate it from other approaches, ( c ) the benefits of using QI together with other change approaches

QI is not a silver bullet for all changes required in healthcare: it has great potential to be used together with other change approaches, either concurrently (using audit to inform iterative tests of change) or consecutively (using QI to adapt published research to local context)

As QI becomes established, opportunities for these collaborations will grow, to the benefit of patients.

The benefits to front line clinicians of participating in quality improvement (QI) activity are promoted in many health systems. QI can represent a valuable opportunity for individuals to be involved in leading and delivering change, from improving individual patient care to transforming services across complex health and care systems. 1

However, it is not clear that this promotion of QI has created greater understanding of QI or widespread adoption. QI largely remains an activity undertaken by experts and early adopters, often in isolation from their peers. 2 There is a danger of a widening gap between this group and the majority of healthcare professionals.

This article will make it easier for those new to QI to understand what it is, where it fits with other approaches to improving care (such as audit or research), when best to use a QI approach, making it easier to understand the relevance and usefulness of QI in delivering better outcomes for patients.

How this article was made

AB and FO are both specialist quality improvement practitioners and have developed their expertise working in QI roles for a variety of UK healthcare organisations. The analysis presented here arose from AB and FO’s observations of the challenges faced when introducing QI, with healthcare providers often unable to distinguish between QI and other change approaches, making it difficult to understand what QI can do for them.

How is quality improvement defined?

There are many definitions of QI ( box 1 ). The BMJ ’s Quality Improvement series uses the Academy of Medical Royal Colleges definition. 6 Rather than viewing QI as a single method or set of tools, it can be more helpful to think of QI as based on a set of principles common to many of these definitions: a systematic continuous approach that aims to solve problems in healthcare, improve service provision, and ultimately provide better outcomes for patients.

Definitions of quality improvement

Improvement in patient outcomes, system performance, and professional development that results from a combined, multidisciplinary approach in how change is delivered. 3

The delivery of healthcare with improved outcomes and lower cost through continuous redesigning of work processes and systems. 4

Using a systematic change method and strategies to improve patient experience and outcome. 5

To make a difference to patients by improving safety, effectiveness, and experience of care by using understanding of our complex healthcare environment, applying a systematic approach, and designing, testing, and implementing changes using real time measurement for improvement. 6

In this article we discuss QI as an approach to improving healthcare that follows the principles outlined in box 2 ; this may be a useful reference to consider how particular methods or tools could be used as part of a QI approach.

Principles of QI

Primary intent— To bring about measurable improvement to a specific aspect of healthcare delivery, often with evidence or theory of what might work but requiring local iterative testing to find the best solution. 7

Employing an iterative process of testing change ideas— Adopting a theory of change which emphasises a continuous process of planning and testing changes, studying and learning from comparing the results to a predicted outcome, and adapting hypotheses in response to results of previous tests. 8 9

Consistent use of an agreed methodology— Many different QI methodologies are available; commonly cited methodologies include the Model for Improvement, Lean, Six Sigma, and Experience-based Co-design. 4 Systematic review shows that the choice of tools or methodologies has little impact on the success of QI provided that the chosen methodology is followed consistently. 10 Though there is no formal agreement on what constitutes a QI tool, it would include activities such as process mapping that can be used within a range of QI methodological approaches. NHS Scotland’s Quality Improvement Hub has a glossary of commonly used tools in QI. 11

Empowerment of front line staff and service users— QI work should engage staff and patients by providing them with the opportunity and skills to contribute to improvement work. Recognition of this need often manifests in drives from senior leadership or management to build QI capability in healthcare organisations, but it also requires that frontline staff and service users feel able to make use of these skills and take ownership of improvement work. 12

Using data to drive improvement— To drive decision making by measuring the impact of tests of change over time and understanding variation in processes and outcomes. Measurement for improvement typically prioritises this narrative approach over concerns around exactness and completeness of data. 13 14

Scale-up and spread, with adaptation to context— As interventions tested using a QI approach are scaled up and the degree of belief in their efficacy increases, it is desirable that they spread outward and be adopted by others. Key to successful diffusion of improvement is the adaption of interventions to new environments, patient and staff groups, available resources, and even personal preferences of healthcare providers in surrounding areas, again using an iterative testing approach. 15 16

What other approaches to improving healthcare are there?

Taking considered action to change healthcare for the better is not new, but QI as a distinct approach to improving healthcare is a relatively recent development. There are many well established approaches to evaluating and making changes to healthcare services in use, and QI will only be adopted more widely if it offers a new perspective or an advantage over other approaches in certain situations.

A non-systematic literature scan identified the following other approaches for making change in healthcare: research, clinical audit, service evaluation, and clinical transformation. We also identified innovation as an important catalyst for change, but we did not consider it an approach to evaluating and changing healthcare services so much as a catch-all term for describing the development and introduction of new ideas into the system. A summary of the different approaches and their definition is shown in box 3 . Many have elements in common with QI, but there are important difference in both intent and application. To be useful to clinicians and managers, QI must find a role within healthcare that complements research, audit, service evaluation, and clinical transformation while retaining the core principles that differentiate it from these approaches.

Alternatives to QI

Research— The attempt to derive generalisable new knowledge by addressing clearly defined questions with systematic and rigorous methods. 17

Clinical audit— A way to find out if healthcare is being provided in line with standards and to let care providers and patients know where their service is doing well, and where there could be improvements. 18

Service evaluation— A process of investigating the effectiveness or efficiency of a service with the purpose of generating information for local decision making about the service. 19

Clinical transformation— An umbrella term for more radical approaches to change; a deliberate, planned process to make dramatic and irreversible changes to how care is delivered. 20

Innovation— To develop and deliver new or improved health policies, systems, products and technologies, and services and delivery methods that improve people’s health. Health innovation responds to unmet needs by employing new ways of thinking and working. 21

Why do we need to make this distinction for QI to succeed?

Improvement in healthcare is 20% technical and 80% human. 22 Essential to that 80% is clear communication, clarity of approach, and a common language. Without this shared understanding of QI as a distinct approach to change, QI work risks straying from the core principles outlined above, making it less likely to succeed. If practitioners cannot communicate clearly with their colleagues about the key principles and differences of a QI approach, there will be mismatched expectations about what QI is and how it is used, lowering the chance that QI work will be effective in improving outcomes for patients. 23

There is also a risk that the language of QI is adopted to describe change efforts regardless of their fidelity to a QI approach, either due to a lack of understanding of QI or a lack of intention to carry it out consistently. 9 Poor fidelity to the core principles of QI reduces its effectiveness and makes its desired outcome less likely, leading to wasted effort by participants and decreasing its credibility. 2 8 24 This in turn further widens the gap between advocates of QI and those inclined to scepticism, and may lead to missed opportunities to use QI more widely, consequently leading to variation in the quality of patient care.

Without articulating the differences between QI and other approaches, there is a risk of not being able to identify where a QI approach can best add value. Conversely, we might be tempted to see QI as a “silver bullet” for every healthcare challenge when a different approach may be more effective. In reality it is not clear that QI will be fit for purpose in tackling all of the wicked problems of healthcare delivery and we must be able to identify the right tool for the job in each situation. 25 Finally, while different approaches will be better suited to different types of challenge, not having a clear understanding of how approaches differ and complement each other may mean missed opportunities for multi-pronged approaches to improving care.

What is the relationship between QI and other approaches such as audit?

Academic journals, healthcare providers, and “arms-length bodies” have made various attempts to distinguish between the different approaches to improving healthcare. 19 26 27 28 However, most comparisons do not include QI or compare QI to only one or two of the other approaches. 7 29 30 31 To make it easier for people to use QI approaches effectively and appropriately, we summarise the similarities, differences, and crossover between QI and other approaches to tackling healthcare challenges ( fig 1 ).

How quality improvement interacts with other approaches to improving healthcare

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QI and research

Research aims to generate new generalisable knowledge, while QI typically involves a combination of generating new knowledge or implementing existing knowledge within a specific setting. 32 Unlike research, including pragmatic research designed to test effectiveness of interventions in real life, QI does not aim to provide generalisable knowledge. In common with QI, research requires a consistent methodology. This method is typically used, however, to prove or disprove a fixed hypothesis rather than the adaptive hypotheses developed through the iterative testing of ideas typical of QI. Both research and QI are interested in the environment where work is conducted, though with different intentions: research aims to eliminate or at least reduce the impact of many variables to create generalisable knowledge, whereas QI seeks to understand what works best in a given context. The rigour of data collection and analysis required for research is much higher; in QI a criterion of “good enough” is often applied.

Relationship with QI

Though the goal of clinical research is to develop new knowledge that will lead to changes in practice, much has been written on the lag time between publication of research evidence and system-wide adoption, leading to delays in patients benefitting from new treatments or interventions. 33 QI offers a way to iteratively test the conditions required to adapt published research findings to the local context of individual healthcare providers, generating new knowledge in the process. Areas with little existing knowledge requiring further research may be identified during improvement activities, which in turn can form research questions for further study. QI and research also intersect in the field of improvement science, the academic study of QI methods which seeks to ensure QI is carried out as effectively as possible. 34

Scenario: QI for translational research

Newly published research shows that a particular physiotherapy intervention is more clinically effective when delivered in short, twice-daily bursts rather than longer, less frequent sessions. A team of hospital physiotherapists wish to implement the change but are unclear how they will manage the shift in workload and how they should introduce this potentially disruptive change to staff and to patients.

Before continuing reading think about your own practice— How would you approach this situation, and how would you use the QI principles described in this article?

Adopting a QI approach, the team realise that, although the change they want to make is already determined, the way in which it is introduced and adapted to their wards is for them to decide. They take time to explain the benefits of the change to colleagues and their current patients, and ask patients how they would best like to receive their extra physiotherapy sessions.

The change is planned and tested for two weeks with one physiotherapist working with a small number of patients. Data are collected each day, including reasons why sessions were missed or refused. The team review the data each day and make iterative changes to the physiotherapist’s schedule, and to the times of day the sessions are offered to patients. Once an improvement is seen, this new way of working is scaled up to all of the patients on the ward.

The findings of the work are fed into a service evaluation of physiotherapy provision across the hospital, which uses the findings of the QI work to make recommendations about how physiotherapy provision should be structured in the future. People feel more positive about the change because they know colleagues who have already made it work in practice.

QI and clinical audit

Clinical audit is closely related to QI: it is often used with the intention of iteratively improving the standard of healthcare, albeit in relation to a pre-determined standard of best practice. 35 When used iteratively, interspersed with improvement action, the clinical audit cycle adheres to many of the principles of QI. However, in practice clinical audit is often used by healthcare organisations as an assurance function, making it less likely to be carried out with a focus on empowering staff and service users to make changes to practice. 36 Furthermore, academic reviews of audit programmes have shown audit to be an ineffective approach to improving quality due to a focus on data collection and analysis without a well developed approach to the action section of the audit cycle. 37 Clinical audits, such as the National Clinical Audit Programme in the UK (NCAPOP), often focus on the management of specific clinical conditions. QI can focus on any part of service delivery and can take a more cross-cutting view which may identify issues and solutions that benefit multiple patient groups and pathways. 30

Audit is often the first step in a QI process and is used to identify improvement opportunities, particularly where compliance with known standards for high quality patient care needs to be improved. Audit can be used to establish a baseline and to analyse the impact of tests of change against the baseline. Also, once an improvement project is under way, audit may form part of rapid cycle evaluation, during the iterative testing phase, to understand the impact of the idea being tested. Regular clinical audit may be a useful assurance tool to help track whether improvements have been sustained over time.

Scenario: Audit and QI

A foundation year 2 (FY2) doctor is asked to complete an audit of a pre-surgical pathway by looking retrospectively through patient documentation. She concludes that adherence to best practice is mixed and recommends: “Remind the team of the importance of being thorough in this respect and re-audit in 6 months.” The results are presented at an audit meeting, but a re-audit a year later by a new FY2 doctor shows similar results.

Before continuing reading think about your own practice— How would you approach this situation, and how would you use the QI principles described in this paper?

Contrast the above with a team-led, rapid cycle audit in which everyone contributes to collecting and reviewing data from the previous week, discussed at a regular team meeting. Though surgical patients are often transient, their experience of care and ideas for improvement are captured during discharge conversations. The team identify and test several iterative changes to care processes. They document and test these changes between audits, leading to sustainable change. Some of the surgeons involved work across multiple hospitals, and spread some of the improvements, with the audit tool, as they go.

QI and service evaluation

In practice, service evaluation is not subject to the same rigorous definition or governance as research or clinical audit, meaning that there are inconsistencies in the methodology for carrying it out. While the primary intent for QI is to make change that will drive improvement, the primary intent for evaluation is to assess the performance of current patient care. 38 Service evaluation may be carried out proactively to assess a service against its stated aims or to review the quality of patient care, or may be commissioned in response to serious patient harm or red flags about service performance. The purpose of service evaluation is to help local decision makers determine whether a service is fit for purpose and, if necessary, identify areas for improvement.

Service evaluation may be used to initiate QI activity by identifying opportunities for change that would benefit from a QI approach. It may also evaluate the impact of changes made using QI, either during the work or after completion to assess sustainability of improvements made. Though likely planned as separate activities, service evaluation and QI may overlap and inform each other as they both develop. Service evaluation may also make a judgment about a service’s readiness for change and identify any barriers to, or prerequisites for, carrying out QI.

QI and clinical transformation

Clinical transformation involves radical, dramatic, and irreversible change—the sort of change that cannot be achieved through continuous improvement alone. As with service evaluation, there is no consensus on what clinical transformation entails, and it may be best thought of as an umbrella term for the large scale reform or redesign of clinical services and the non-clinical services that support them. 20 39 While it is possible to carry out transformation activity that uses elements of QI approach, such as effective engagement of the staff and patients involved, QI which rests on iterative test of change cannot have a transformational approach—that is, one-off, irreversible change.

There is opportunity to use QI to identify and test ideas before full scale clinical transformation is implemented. This has the benefit of engaging staff and patients in the clinical transformation process and increasing the degree of belief that clinical transformation will be effective or beneficial. Transformation activity, once completed, could be followed up with QI activity to drive continuous improvement of the new process or allow adaption of new ways of working. As interventions made using QI are scaled up and spread, the line between QI and transformation may seem to blur. The shift from QI to transformation occurs when the intention of the work shifts away from continuous testing and adaptation into the wholesale implementation of an agreed solution.

Scenario: QI and clinical transformation

An NHS trust’s human resources (HR) team is struggling to manage its junior doctor placements, rotas, and on-call duties, which is causing tension and has led to concern about medical cover and patient safety out of hours. A neighbouring trust has launched a smartphone app that supports clinicians and HR colleagues to manage these processes with the great success.

This problem feels ripe for a transformation approach—to launch the app across the trust, confident that it will solve the trust’s problems.

Before continuing reading think about your own organisation— What do you think will happen, and how would you use the QI principles described in this article for this situation?

Outcome without QI

Unfortunately, the HR team haven’t taken the time to understand the underlying problems with their current system, which revolve around poor communication and clarity from the HR team, based on not knowing who to contact and being unable to answer questions. HR assume that because the app has been a success elsewhere, it will work here as well.

People get excited about the new app and the benefits it will bring, but no consideration is given to the processes and relationships that need to be in place to make it work. The app is launched with a high profile campaign and adoption is high, but the same issues continue. The HR team are confused as to why things didn’t work.

Outcome with QI

Although the app has worked elsewhere, rolling it out without adapting it to local context is a risk – one which application of QI principles can mitigate.

HR pilot the app in a volunteer specialty after spending time speaking to clinicians to better understand their needs. They carry out several tests of change, ironing out issues with the process as they go, using issues logged and clinician feedback as a source of data. When they are confident the app works for them, they expand out to a directorate, a division, and finally the transformational step of an organisation-wide rollout can be taken.

Education into practice

Next time when faced with what looks like a quality improvement (QI) opportunity, consider asking:

How do you know that QI is the best approach to this situation? What else might be appropriate?

Have you considered how to ensure you implement QI according to the principles described above?

Is there opportunity to use other approaches in tandem with QI for a more effective result?

How patients were involved in the creation of this article

This article was conceived and developed in response to conversations with clinicians and patients working together on co-produced quality improvement and research projects in a large UK hospital. The first iteration of the article was reviewed by an expert patient, and, in response to their feedback, we have sought to make clearer the link between understanding the issues raised and better patient care.

Contributors: This work was initially conceived by AB. AB and FO were responsible for the research and drafting of the article. AB is the guarantor of the article.

Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

Provenance and peer review: This article is part of a series commissioned by The BMJ based on ideas generated by a joint editorial group with members from the Health Foundation and The BMJ , including a patient/carer. The BMJ retained full editorial control over external peer review, editing, and publication. Open access fees and The BMJ ’s quality improvement editor post are funded by the Health Foundation.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

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Measuring Outcomes of Quality Improvement Essay

The insights of this thought-provoking discussion post suggest that quality improvement (QI) is intertwined with technical and behavioral models that encourage improving services and products. Therefore, nursing professionals are advised to establish reasonable goals and effective methods using several trials. This position mentioned in the post leads to new ideas, such as QI strategies, that should deepen this discussion further. Identifying goals and methods is indeed essential but without determining efficient strategies such as Root cause analysis and Plan–Do–Study–Act cycles, the process fails (Toles et al., 2021). These strategies should help evaluate the outcomes of quality improvement, identify the causes of quality deficits, and suggest improvements in nursing.

For measuring the outcomes, the nursing professionals focus on the factors initiated by the setting and providers. For example, the service outcomes encompass quality, efficiency, safety, equity, and patient-centeredness. Beyond that, the novel concept in nursing is empowering professionals instead of controlling them, meaning that their work should be assessed using new criteria. The significance of the measurement for nursing outcomes is justified by the given post since it highlights the dominating value of cooperation between the team members. However, the question about the value of measuring nursing leaders’ success and patients remains unaddressed. Answering it requires the new outcome measuring system based only on the professionals, who should become more competent and comfortable with the idea of constant change (Kelly & Quesnelle, 2016). They are responsible for identifying the problems, proposing solutions, and integrating them into the routine, thus, raising the importance of the outcomes that matter to patients. Hence, quality improvement redesigns the interprofessional team-based care of patients. The more aware is the nursing leaders, the more successful the organization.

Kelly, P., & Quesnelle, H. (2016). Chapter 8 Nursing leadership and management. In Nursing leadership and management (3rd Canadian ed.) (pp. 170-173). Toronto, ON: Nelson Education.

Toles, M., Colón-Emeric, C., Moreton, E., Frey, L., & Leeman, J. (2021). Quality improvement studies in nursing homes: a scoping review. BMC Health Services Research , 21 (1), 803.

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