Data from NDNQI have been used at the state level for public reporting, driving state initiatives, and supporting staffing legislation that defends the hospital and the nursing unit‐level leaderships’ rights to make decisions about safe staffing levels based on the evidence, rather than on state‐mandated ratios. Major insurers provide higher ratings to those institutions that participate in NDNQI, based on their conviction that institutions that care about nursing care quality are more likely to have positive outcomes.
In 2014 ANA made a decision to divest itself of NDNQI and arranged for its purchase by Press Ganey, an established for‐profit business that supports data collection and reporting on the patient experience of care. ANA retains stewardship of certain NDNQI measures and an advisory role in the further development of NDNQI. Press Ganey still owns NDNQI and manages the approximately 2,000 hospitals that collect, report, and compare 17 quality outcome indicators of nursing quality, identifying annually those hospitals receiving awards for Outstanding Nursing Quality. NDNQI has long worked to expand its footprint in other countries around the globe as well, from the Middle East and India to Europe and Asia.
Institute for Healthcare Improvement Focused on System Improvement
Founded in 1991, the Institute for Healthcare Improvement (IHI) has been a major driver of quality care and health care change, based on the philosophy that almost any product or service, including health care, can be improved. The IHI encouraged systems thinking with implementation of a systems idea: if one can change the way things are done, one can get better results. IHI aims to improve the lives of patients, the health of communities, and the joy of the health care workforce by focusing on the IOM’s six improvement aims for the health care system: safety, effectiveness, patient‐centeredness, timeliness, efficiency, and equity (Institute of Medicine, 2001). IHI may be best known for its campaigns to Save 100,000 Lives, later to Save Five Million Lives, and currently the Triple Aim initiatives of better care, better health, at lower cost. IHI provides a variety of services and educational programs and tools to assist hospitals and other stakeholders to achieve these aims. Its structure and campaigns have enabled institutions and individual providers of care, including nurses, to share their “near misses” and successes in instructive ways. Nursing organizations have participated in IHI to contribute to discussions and to influence actions that have global and national consequences. Today, not only is IHI an influential force in health and health care improvement in the United States, it has expanded its footprint to many countries around the world, including Canada, England, Scotland, Denmark, Sweden, Singapore, Latin America, New Zealand, Ghana, Malawi, South Africa, the Middle East, and elsewhere.
In 2018 IHI convened the National Steering Committee (NSC) for Patient Safety (within which several nurse leaders participate), resulting in 2020 in the release of Safer Together: A National Action Plan to Advance Patient Safety (IHI, 2020), described in Textbox 2.2. The Steering Committee, in developing this plan and its companion components, dedicated itself to reducing preventable harm in every setting, whether acute, long‐term, or home‐based care, and for patients, caregivers, and health care workers alike.
NSC members also identified three cross‐cutting themes that are integral to the four foundational areas and recommendations in the National Action Plan, as described in Textbox 2.3.
As part of the IHI initiative, it released two supplementary resources to provide detailed guidance: a Self‐Assessment Tool to assist leaders and organizations in deciding where to start, and an Implementation Resource Guide detailing tactics and supporting resources for implementing the National Action Plan recommendations (http://www.ihi.org/Engage/Initiatives/National‐Steering‐Committee‐Patient‐Safety/Pages/default.aspx).
Textbox 2.2 Safer Together: A National Action Plan to Advance Patient Safety
The National Action Plan's four foundational and interdependent areas:
Culture, leadership, and governance: The imperative for leaders, governance bodies, and policy‐makers to demonstrate and foster our deeply held professional commitments to safety as a core value and promote the development of cultures of safety.
Patient and family engagement: The spread of authentic patient and family engagement; the practice of co‐designing and co‐producing care with patients, families, and care partners to ensure their meaningful partnership in all aspects of care design, delivery, and operations.
Workforce safety: Ensuring the safety and resiliency of the organization and the workforce is a necessary precondition to advancing patient safety; we need to work toward a unified, total systems‐based perspective and approach to eliminate harm to both patients and the workforce.
Learning system: Establishing networked and continuous learning; forging learning systems within and across health care organizations at the local, regional, and national levels to encourage widespread sharing, learning, and improvement (Institute for Healthcare Improvement, 2020).
Textbox 2.3 Institute for Healthcare Improvement National Action Plan Cross‐Cutting Themes
Person‐centered care: Patients, families, and care partners experience lifelong care journeys across the entire continuum of care. They have a unique and essential perspective on care delivery, and their insights on “what matters” are critical for creating safer care.
Care across the entire continuum: Care is provided in locations outside of hospitals, including ambulatory, long‐term care facilities, home, and other community‐based settings. The recommendations in the National Action Plan are meant to be relevant to all settings across the care continuum.
The relationship between patient safety and health equity: Health inequities are “linked to the complicated history and reality of racism, classism, sexism, ableism, ageism, and other forms of oppression.” Inequities result in a concentration of harm in specific population groups, based on characteristics such as race, ethnicity, sexual orientation, gender, age, disability, and income, and must be considered when designing safety efforts to ensure that inequities are being addressed.
Informatics, Electronic Health Records, and Impact of Technology on Quality and Policy
While also helping align the health care industry with quality expectations in other industries, dialogue about the use of technology, nursing terminologies, and consistent specifications for data capture, including physician order entry, diagnoses, interventions, and decision support, became part of the quality discussion. Harnessing complex technology for quality improvement and reporting purposes has become crucial.
Data collection burdens, the accuracy of electronic data extractions, the timeliness of data reporting and analysis, the ability to have timely comparisons to benchmarks—all of these impact not only the performance improvement process, but also the ability to ensure that patients are receiving the care they deserve within a safety culture. This was