150 unit 2 | Working Within the Organization
Also having a multifaceted mission, the
renowned Robert Wood Johnson Foundation
(RWJF) serves multiple missions and seeks to
improve health and health care for all Americans.
RWJF’s success comes from leveraging partner-
ships and its endowment to “building evidence and
producing, synthesizing and distributing knowl-
edge, new ideas and expertise” (RWJF, 2008) in
eight program areas. RWJF is responsible for
sucessfully funded projects and research that
improve quality and safety for all Americans.
The Leapfrog Group is a nonprofit organiza-
tion interested in improving safety, quality, and
affordability of health care through incentives and
rewards to those who use and pay for health care
(Leapfrog Group, 2007). With a focus on reducing
preventable medical mistakes, the Leapfrog Group
touted their benefits to improve safety and quality
to consumers and business owners with three leaps:
(a) improve transparency by reporting hospital
survey results addressing quality and safety indica-
tors; (b) incentivize better quality and safety
performance; and (c) collaborate with other orga-
nizations to improve quality and safety. To date,
there is limited evidence that the Leapfrog Group
has effectively improved quality or safety.
Limitations to success may be in part because too
few hospitals have participated in the surveys and
too few consumers have used the available infor-
mation to make health decisions; however, there is
an indication that, with time, participation could
improve with adjustments in strategy by the
Leapfrog Group (Galvin, Delbanco, Milstein, &
Belden, 2005).
Quality Organizations
Each of the quality organizations strives to improve
system-wide quality for Americans through a vari-
ety of programs and methods.
The National Committee for Quality Assurance
(NCQA) was established in 1990 to accredit health
plans and certify organizations. Its success in sup-
porting quality and safety resides in its Health
Effectiveness Data and Information Set (HEDIS).
Over 90% of U.S. health plans use HEDIS to
measure performance. HEDIS allows for con-
sumers and employers to evaluate health plans
using data from HEDIS as a report card of the
plan’s success.
JC was established in 1951 with a focus on
structural measures of quality, assessment of the
physical plant, number of patient beds per nurse,
credentialing of service providers, and other
standards for each department. This system of
evaluation has given way to a more process- and
outcome-focused model: CQI. Today, the JC
accredits more than 19,000 health-care organiza-
tions. Evaluation of nursing services is an impor-
tant part of the accreditation. JC–accredited
agencies are measured against national standards
set by health-care professionals. Hospitals,
health-care networks, long-term care facilities,
ambulatory care centers, home health agencies,
behavioral health-care facilities, and clinical
laboratories are among the organizations seeking
JC accreditation. Although accreditation by the
JC is voluntary, Medicare and Medicaid reim-
bursement cannot be sought by organizations not
accredited by JCAHO.Integrating Initiatives and
Evidenced-Based
Practices Into Patient Care
As you familiarize yourself with each of these
organizations and their respective initiatives, con-
sider how they will affect the management of
patient care. Your responsibility as a professional
RN is to acknowledge their presence, understand
and value their importance, and participate in your
facility-adopted initiatives and evidence-based
practices. Additionally, as a leader and manager, you
will be expected to drive changes based upon
endeavors of many of these organizations, agencies,
and initiatives ensuring that quality and safety con-
tinue to improve.Health-Care System Reform
Eighty-two percent of Americans believe the U.S.
health-care system is in need of either fundamental
change or complete rebuilding (How, Shih, Lau,
& Shoen, 2008). Americans want leadership to
address quality, cost, coverage, and access. The
debate rests on how best to achieve necessary
reform.
The IOM report proposed five core compe-
tencies (Box 10-10) in which all health-care
professionals will need to be effective as providers
and leaders in the 21st-century health-care
system.
By integrating these competencies into
21st-century health profession education, you can
begin to support health-care reform while managing