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In Nursing, Accountability Fosters Quality

Michelle Wilson Berger for HealthLeaders Media, July 31, 2012

A go-to metric
All three facilities take part in the National Database of Nurse Quality Indicators, a 14-year-old tool developed as part of the ANA's Safety and Quality Initiative. As of April, 1,813 hospitals in all 50 states and Washington, D.C., participated. That's more than 30% of all registered U.S. hospitals.

"It is the nation's most comprehensive database," says Bridget Johnson, Parkview Whitley's vice president of patient services. "We use this to look at performance indicators that measure nursing quality." In fact, the entire Parkview Health system employs the database, which takes a three-pronged approach to nursing care, looking at structure, process, and patient outcomes. Facilities select which of the 20-plus metrics—they range from patient falls to nurse turnover rates—they want regular reporting on.

Hospitals (and units within) receive comparisons based on bed size or teaching status only. For example, as a regional medical center with 225 staffed beds, Poudre Valley falls into NDNQI's 200–299 bed range and its teaching hospital status. So its benchmark scores would never be side by side with those of a 20-bed community hospital. "If it's a medical unit in one place, we're compared to a medical unit in another place. That's important," says Donna D. Poduska, MS, RN, NE-BC, NEA-BC, vice president and chief nursing officer at the Colorado facility. "Different populations of patients will be on the medical unit versus the women's care unit, so you're really comparing apples to apples that way."

Often, it's the first time these hospitals see how they stack up against similar facilities, and the results tend to motivate change, Johnson adds. When Parkview Whitley's patient falls spiked in mid-2010—something unknown to hospital leadership before seeing the NDNQI data—an action plan was quickly developed. "We were able to drive that number down and keep that number down," Johnson says, "based on personal alarms, hourly rounding, bedside shift reports." In the end, the action plan engaged the nursing staff, which made them accountable to improving the numbers.

Robert Wood Johnson Hospital asks its nurses to complete the annual NDNQI job satisfaction survey. "We look at those metrics to see how satisfied our nurses are with respect to their units," Easter says. "RN satisfaction is directly related to our other quality outcomes."

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