Читать книгу Quality and Safety in Nursing - Группа авторов - Страница 50

Mary Jean Schumann, DNP, MBA, RN, CPNP‐PC, FAAN

Even though individual providers and clinicians of every discipline can elect to improve their own practice, strive to provide higher‐quality care, and reduce errors in their own work environments, much of the effort to reach higher levels of quality and safety must also occur through high‐level policy setting and health system reforms. Without policies that focus prioritization of resources on quality health care as a goal, individual efforts will be subsumed by other challenges such as stressful working conditions, short staffing and limited access, and demands for cost containment. This chapter addresses the policy strategies and initiatives that have emerged since 1990, from coalition building, to standard setting, to rule‐making and regulation, to the development of new incentives, to forging of new partnerships with consumer groups, and even legislation. Nurses’ roles in these efforts will also be described, as well as opportunities to influence policy, priorities, outcomes, and implementation today and in the decade that follows. Although quality and safety are distinct, the inclusion of safety is considered in any discussion of health care quality. Because so many measures of health care quality seem rooted in the absence of negative outcomes, such as falls, development of infections, pressure ulcers, misdiagnoses, and harm as a result of medication errors, safety has become synonymous with quality improvement in many discussions. Yet, as the last decade has reinforced, this is not enough. Access to care, cost, social determinants of health, health disparities, and emerging and infectious diseases have confounded incremental efforts to improve quality and safety. Policy‐makers, nurses, and others have had to engage in policy that impacts each of those factors effectively to make a difference.