chapter 10 | Quality and Safety 137■Assists benchmarking and performance
monitoring
■Stimulates change and becomes the building block
for the next plan (planware.org/strategy.htm)
During the strategic planning process, the organi-
zation develops or reviews its vision, mission state-
ment, and corporate values. A group develops
business objectives and key strategies to meet these
objectives. In order to do this, a SWOT analysis is
done—a review of the organization’s Strengths,
Weaknesses, Opportunities, and Threats. Key
strategies are identified, and action plans are devel-
oped. The organization’s mission, goals, and strate-
gic plan ultimately drive the outcomes and QI plan
for that organization. Be proactive, and participate
in the process. Ask your nurse manager if there are
opportunities for the staff to participate in the
planning process.
Issues related to QI may also come out of the
strategic planning process. Quality issues are not
often apparent to senior managers. Staff members
at the unit level can often identify quality issues
because they are the ones who can feel the impact
when quality is lacking. Once a process that needs
improvement is identified, an interdisciplinary
team is organized whose members have knowledge
of the identified process. The team members meet
to identify and analyze problems, discuss solutions,
and evaluate changes. The team clarifies the cur-
rent knowledge of the process; it identifies causes
for variations in the process and works to unify the
process. Box 10-6 identifies questions that team
members might ask as they work on the QI plan.
Structured Care Methodologies
Most agencies have tools for tracking outcomes.
These tools are called structured care methodologies
(SCMs). SCMs are interdisciplinary tools to “iden-
tify best practices, facilitate standardization of care,
and provide a mechanism for variance tracking,
quality enhancement, outcomes measurement, and
outcomes research” (Cole & Houston, 1999, p. 53).
SCMs include guidelines, protocols, algorithms,
standards of care, critical pathways, and order sets.■Guidelines.Guidelines first appeared in the
1980s as statements to assist health-care
providers and patients in making appropriate
health-care decisions. Guidelines are based on
current research strategies and are often devel-
oped by experts in the field. The use of guidelines
is seen as a way to decrease variations in practice.
■Protocols.Protocols are specific, formal docu-
ments that outline how a procedure or interven-
tion should be conducted. Protocols have been
used for many years in research and specialty
areas but have been introduced into general
health care as a way to standardize approaches
to achieve desired outcomes. An example in
many facilities is a chest pain protocol.
■Algorithms.Algorithms are systematic proce-
dures that follow a logical progression based on
additional information or patient responses to
treatment. They were originally developed in
mathematics and are frequently seen in
emergency medical services. Advanced cardiac
life support algorithms are now widely used in
health-care agencies.
■Standards of care.Standards of care are often
discipline-related and help to operationalize
patient care processes and provide a baseline for
quality care. Lawyers often refer to a discipline’s
standards of care in evaluating whether a patient
has received appropriate services.
■Critical (or clinical) pathways.A critical path-
way outlines the expected course of treatment
for patients with similar diagnoses. The critical
pathway should orient the nurse easily to the
patient outcomes for the day. In some institu-
tions, nursing diagnoses with specific time
frames are incorporated into the critical path-
way, which describes the course of events that
lead to successful patient outcome within the
diagnosis-related group (DRG)–defined time
frame. For the patient with an uncomplicatedbox 10-6
Questions the Team Needs to Ask
1.Who are our customers, stakeholders, markets?
2.What do they expect from us?
3.What are we trying to accomplish?
4.What changes do we think will make an improvement?
5.How and when will we pilot-test our predicted
improvement?
6.What do we expect to learn from the pilot test?
7.What will we do with negative results? positive results?
8.How will we implement the change?
9.How will we measure success?
10.What did we learn as a team from this experience?- What changes would we make for the future?
Adapted from McLaughlin, C., & Kaluzny, A. (2006). Continuous Quality
Improvement in Health Care: Theory, Implementations, and Applications.
3rd ed. Massachusetts: Jones & Bartlett.