8: QUALITY IMPROVEMENT AND PATIENT SAFETY INITIATIVES ■ 205Building on the documented credibility nurses have in assuming leadership in
QI and patient safety activities, DNPs now have an increased opportunity to impact
on system transformation through development and implementation of innovative
and credible QI strategies and program designs. Yet specific QI strategies, approaches,
and tools are often absent from DNP curriculum. Widespread confusion and debate
regarding appropriate practice- based scholarship lends credence to this concern. The
AACN’s (2015) white paper on DNP implementation addresses this inconsistency and
the need again to clarify the contrast of what is considered practice- based scholarship
versus research- based scholarship. Specific recommendations are made in the white
paper regarding program refinements that would assure achievement of DNP compe-
tencies and, when implemented, would provide more consistency in the DNP role. One
of AACN’s most important recommendations is the need to generate opportunities
for faculty development in the areas of QI methods and measurements. Many PhD-
prepared faculty have little knowledge or experience in developing or implementing
QI activities, yet, they are expected to guide their DNP students through this process in
diverse health care systems. Furthermore, they are expected to evaluate the relevance
of these practice- based QI projects with little contact with the context in which they
are implemented. This mismatch between the expectations for DNP leadership in QI
and the inconsistency in DNP education in this area has created a missed opportunity
for nursing to assume a leadership role in health care reform. Improvement of this
aspect of DNP education is vital, as it will increase DNPs’ opportunities to achieve the
requisite skills, knowledge, and abilities needed to lead QI in the setting in which they
practice.
This chapter focuses on the available strategies and programs developed in concert
with the implementation of the ACA and the NQS that could be the foundation for the
required DNP program development. Through federal and national foundation grant
supports over the past 10 years, significant progress has been made in the develop-
ment of evidence- based QI approaches. This chapter reviews three significant initiatives
available to the DNP faculty and students for building learning opportunities. These
include: (a) AHRQ’s (2014a) tools and evidence-based practice ( EBP) quality indicators;
(b) Centers for Disease Control and Prevention (CDC, 2012) Program Evaluation model;
and (c) IHI’s (2016) Open School for QI education.
Acknowledgment is given to the Centers for Medicaid and Medicare Service,
the Robert Wood Johnson Foundation, and the Kellogg Foundation for supporting the
development of these national initiatives and strengthening the education of health care
professionals who will lead the reform needed to meet the Triple Aim. For the nurs-
ing profession, poised to assume leadership in this transformation, a more significant
and concerted effort by leaders in nursing education and practice is needed to join this
national forum. This can be accomplished by strengthening the leadership role of the
DNP in developing QI in all settings in which they practice.
■ NATIONAL STRATEGY FOR QI
The use of the terms quality health care and QI are pervasive in discussions related to
health care reform. What do they mean, and how can they be implemented? As men-
tioned in the previous section, the IHI (2008) defined goals for health care reform as the
Triple Aim: improving population health, improving the patient experience of care, and reduc-
ing per capita cost, which became the organizing framework. In response to the ACA’s
mandate to increase access to high- quality, affordable health care for all Americans, the
Secretary of the Department of Health and Human Services (HHS, 2010) established the