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In this competency, nurses use data to monitor the outcomes of care processes. They also use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. As part of the nursing process, direct care nurses evaluate the care they deliver to each patient. In addition, direct care nurses work together to improve the outcomes of care for the populations served in the care setting. Clinical nurses and nurse leaders identify gaps between local outcomes and best practice outcomes. Nurse leaders lead and provide resources for quality improvement efforts, including access to quality data, quality improvement tools, and quality experts.

An HRO has a strong commitment to health care process improvement. Becoming an HRO requires that the organization systematically review the complexity of health care processes, identify the root causes of failures, implement solutions, measure and monitor outcomes, and sustain the improvement. In some cases, an entirely new process may be required to enhance safety. Increasingly, patients and their families are being engaged to assist in health care process improvements. Quality improvement is described in greater detail in Chapter 18.