Introduction
When implementing health initiatives, it is essential to evaluate their success after the fact. Quality and safety are two particularly relevant indicators, as they determine whether the intervention improves outcomes and is not associated with danger. However, the determination of each of these factors can be complicated due to the complexity of human health and the numerous factors that can affect it. To simplify the process, scholars and regulatory agencies have tried to formulate a comprehensive set of various measures and methods of evaluating them. As such, practitioners who intend to participate in a quality improvement project should investigate the topic and use evidence to formulate a specific set of measures. This paper will attempt to define quality and safety measures, describe their position in nursing science, and identify the components that are required for a program’s evaluation.
Definition and Scholarly Relevance
As indicated by their names, quality and safety measures are used to evaluate their respective traits. According to Sherwood and Barnsteiner (2017), quality indicators emerged as a result of the need to prove the American Nurses Association’s claims that the quality of nursing was declining in the 1990s. Specific, quantifiable data was necessary to achieve the goal, but it was not available at the time. To combat the problem, the organization started promoting data collection and analysis and formulated a set of values that could be used as quality indicators. A similar process likely took place concerning safety measures, though not necessarily for the same reasons. Over time, the original standards have been refined and adapted to suit a variety of contexts and needs.
Quality and safety measures are closely related, as both of these categories have the ultimate aim of improving patient well-being. Dlugacz (2017) refers to safety as a subset of overall quality, though he also highlights its importance. A high-quality environment or intervention will ensure patient safety and excellent outcomes. However, it also has to address metrics such as costs, efficiency, and other items that can contribute to the organization’s ability to deliver superior care to as many people as possible. With that said, improvements that jeopardize patient safety are generally frowned upon because of its position of critical importance. As such, safety measures warrant a separate mention and a considerable effort aimed at evaluating them.
Due to the wide variety of possible quality and safety benchmarks as well as ways to interpret them, nursing science is trying to create a standardized set that has unambiguous implications. Fitzpatrick (2017) mentions that the National Quality Forum has endorsed a set of “15 process, structure, and outcome measures deemed to be nurse-sensitive performance measures,” though it has been shortened to 12 since (p. 525). These guidelines can generally be considered trustworthy and are used to evaluate the quality of various proposed interventions. As such, they are highly relevant to nursing science and warrant extensive consideration on the part of the prospective researcher. Their observation is essential to the success of any initiative, as it can provide evidence of its improved success over that of current methods.
Contemporary Application Examples
The primary purpose of a quality indicator is to identify the existence of any potential issues so that the people responsible for the intervention can address it. As Chang and Daly (2019) highlight, they are quantitative rather than qualitative, highlighting outliers without explaining why they may emerge. As such, quality and safety measures can signal that an issue has appeared in an environment and prompt an investigation into the reasons. Afterward, they can demonstrate whether the findings and subsequent actions were appropriate to the situation, with improvements in the performance measurements indicating success. Through the continued review and analysis of various measures, healthcare facilities can maintain a high standard of care quality and review potential improvements.
Quality measures are particularly relevant to leaders and managers, whose responsibility it is to ensure the delivery of excellent care. Dlugacz (2017) highlights them as signs that a broad reorientation of the overall care process is necessary to address issues. As such, the leadership of an individual or group that can oversee the ongoing operations at the facility is highly beneficial for the implementation of strategies that can address emerging concerns. To assist leaders in this process, organizations such as the American Nurses Association have implemented nationwide databases of quality indicators (Sherwood & Barnsteiner, 2017). They can be used to demonstrate what facilities and regions perform well or poorly compared to the average. However, in addition to comparisons between current facilities, quality and safety indicators are also essential in ongoing research.
In addition to evidence-based measures that are aimed to address the lacking performance of a specific facility, the rules discussed above may be used to judge the success of new initiatives. While it is desirable for most or all healthcare facilities to follow the same high standard of care, continuous improvements to that average level are also critical. Sherwood and Barnsteiner (2017) highlight the National Database of Nursing Quality Indicators and its contributions to policy, performance improvements, and the ability of leaders to make decisions based on the evidence rather than conjecture. Due to the existence of a broad frame of comparison, it is possible to identify significant improvements and test their applicability to various environments. However, because of the importance of specific information databases, it is critical to use quality and safety indicators that can be directly compared to their information.
Health Care Program Outcome Components
A health care program’s purpose is to ensure that an improved standard of care is delivered to a particular patient category. As such, for its successful implementation, it is necessary to understand current issues and the improvements that the program generates. Stanhope and Lancaster (2017) identify several pertinent questions, such as those of the quality and necessity of current methods as well as potential improvements or abandonment. Quality and safety measures can help answer most or all of these questions by identifying issues and suggesting improvements or possible alternatives. Additionally, they can highlight the specific strengths and weaknesses of a particular intervention compared to the various options. However, researchers should be aware of the numerous confounding factors that can affect the quality and safety measures of the program.
For community-based initiatives, it is essential to consider the variety of factors that take place beyond the scope of direct worker intervention. Leung and van Merode (2018) highlight sociotechnical factors such as “clinical complexity, social determinants of health, and patient preferences” (p. 204). When using quality and safety measures to determine whether the program was valid, the practitioner should monitor potential changes in these factors that may have been associated with improvements or declines in performance. Data analysis is beneficial for this practice, as it can summarize community information and discover trends that would not be apparent to a human observer. Ideally, the program should take advantage of such tendencies and try to synergize with them. Alternately, if the changes are negative, it should seek to counteract or reverse them.
Specific tools can be useful to provide an enhanced perspective of the quality and safety outcomes of the program. Rovinski-Wagner and Mills (2018) recommend the usage of the Institute for Healthcare Improvement Global Trigger Tool for safety evaluations due to its selection of useful information and the ability to conduct in-depth retrospective analysis. Evidence-based instruments can improve the trustworthiness of the program and put the new intervention into a framework that matches that of prior research for improved adaptability. Moreover, they can identify factors that the practitioner may have overlooked, further improving the quality of the program. Overall, the selection of potentially influential factors is broad and diverse, and practitioners have to choose the most relevant ones for the problem.
Conclusion
Quality and safety measures are critical for the successful execution of healthcare programs. They were introduced to create a quantitative and objective standard of performance for comparisons and the identification of potential problems. Safety measures can be considered a subset of quality measures, but they are often differentiated in healthcare due to their importance. In nursing science, these indicators are used to evaluate the success of current practices as well as the benefits offered by specific programs. However, it is essential to understand the number and diversity of the various components that constitute a health care intervention before trying to evaluate them. Numerous independent factors can be involved, especially in community healthcare, and it is essential to use evidence-based practice in both implementation and evaluation.
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