In your prelicensure nursing education program, what did you learn about quality improvement in nursing? How was quality improvement emphasized? As you consider nursing education today, what would you suggest be included in future education or orientation programs about the important topic of quality improvement in nursing?
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From the late 1990s, the quality of healthcare has been a growing concern for many Americans and various reports made it clear that Americans were not receiving the quality care they should be receiving (Chassin, Galvin, & The National Roundtable on Health Care Quality, 1998; Institute of Medicine, 2000, 2001; President’s Advisory Commission, 1998). The Institute of Medicine (IOM) concluded that an underlying reason for inadequate quality of care was the outmoded and increasingly complex system in which healthcare was delivered (IOM, 2001).
To solve system-wide problems causing quality deterioration, the concept of quality improvement (QI) was introduced to healthcare from the manufacturing industry (Lighter, 1999). The QI model adopted in healthcare is based on principles that increase productivity, reduce costs, and make institutions more competitive (Bennett & Slavin, 2002).The model focuses on identifying defects and wastes in the hospital’s service line and streamlining the process to produce better outcomes. The goal of QI in healthcare has focused on improving outcomes such as morbidity, medication errors, re-admission, length of stay, and mortality through streamlining treatment process.
Using the principles of the QI model from manufacturing industry, healthcare QI activities became highly centralized and tightly controlled by standards and regulations. Quality of care is perceived as a property of the system rather than a property of individual care providers. This QI model tends to disregard healthcare workers’ expertise and professional judgment, replacing these instead with rules and protocols intended to streamline the complex system.
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