In Nursing, Accountability Fosters Quality

Unique approaches to maintaining quality
All three hospitals aim to exceed national benchmarks, instilling a mind-set that teaches their nurses to go beyond what's expected. With that comes implementation of unique systems to measure and maintain quality. Robert Wood Johnson, for instance, developed what it calls M and Ms (mistakes and misjudgments). During one of these sessions, a nurse who makes an error or who doesn't meet a benchmark works with a clinical nurse educator to reflect on the situation. Together they take stock of what happened, look at the metrics, understand how those translate into daily practice, and then implement changes.

The facility also designates one performance improvement analyst for each unit, a registered nurse who takes eight hours every month—a PI day, the nurses call it—to collect data and make recommendations. "Peer to peer, they address the issues if something falls out of alignment," Easter says. "That's a unique model, for them to really address it in real time." She gives the example of catheter-associated urinary tract infections. The PI analyst evaluates how many days a catheter has been in place, where the Foley bag sits compared to the bladder, whether the catheter is attached to the leg—proven infection-prevention methods. "They make sure that that is all in place," she adds. "If it's not, they have a real-time conversation with the nurse caring for the patient. They make sure all team members—not only our registered nursing staff, but also our unlicensed assistive personnel—are also on the same page."