8: QUALITY IMPROVEMENT AND PATIENT SAFETY INITIATIVES ■ 209is an example of performance measures that can guide hospitals in developing specific
performance measures. The measures are often conceptualized in systems terms; that
is, they may address inputs (staffing and resources), process (program activities), and
output (client’s health outcomes). Participating in this national approach can be use-
ful in comparing the individual organization’s performance against peer health care
organizations, as well as flagging potential problem areas in the program that may be
affecting quality of care.
Program evaluations go beyond these discreet performance measures and look at
this data from the context of the program as a whole. Relationships between program
components across program settings and services are examined to determine how a
program is performing in achieving the desired outcomes for the program participants.
This analysis can identify how program performance is influenced, not just one area of
service, but in combinations that could point to causal impact of several services impact-
ing on each other. For example, analysis of relationships between process indicators
(e.g., nursing staffing in the intensive care units [ICUs]) with postoperative infection
rates or of mortality rates by surgery can provide important insight into the source of
quality problems within specific programs within the organization (e.g., inpatient surgi-
cal service).
Performance measures can be useful to decision makers in providing on going,
continuous indicators of program achievement in priority areas. This system can
provide an early warning system to the management to facilitate identifying system
deficiencies. Program evaluation data are more in depth and are based on studies con-
ducted periodically. This assessment is based on analysis of multiple sources of data
considered within an organizational context and provides an assessment of how the
overall program is functioning and areas for adjustment. Both approaches to quality
measurement are important in communicating to internal and external stakehold-
ers of how the organization is performing and activities involved in improving this
performance.
The CDC (2012) provided the Self Study Guide Introduction to Program Evaluation
for Public Health Programs, which supports systematic program evaluation across pub-
lic health programs across the United States. This practical tool summarizes essential
elements of program evaluation, including steps and standards as well as the means to
include contextual consideration and analysis. This framework describes types of pro-
gram evaluations that can be selected for use. This selection is based on the age of the
program and the questions being asked within the evaluation. What questions, who is
asking them, and what will be done with the information are important questions to ask
when determining which evaluation approach will be used ( Table 8.5 ). The availability
of time and resources also influence the selection of the evaluation design. Process and
outcome evaluation designs are the most commonly used; however, cost– benefit evalu-
ations are of particular use when determining the best use of limited resources. DNP
educators and students could make use of this model in developing a standardized
evidence- based approach to systematic program evaluation consistent with a DNP project.
■ PATIENT AND HEALTH CARE SAFETY
Eliminating medical errors and improving patient safety is one of the major drivers
for health care transformation. Achieving a culture of patient safety requires under-
standing what values and beliefs are important in an organization and what attitudes
and behaviors related to patient safety are supported, rewarded, and expected. Patient