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Using Evidence to Guide Decision Making and Management Practices

Modern medical practices have idealized Evidence-Based Practice as a core element of nursing practice. This has been necessitated by growth in stature of nurses as frontline healthcare workers in remote settings (Kim & Yun, 2019). This paper highlights draws from qualitative and quantitative literature to explore evidence for use in decision making and management practices with specific focus on how the nurse leader can crystallize quality healthcare terms, and quality and regulatory organizations to achieve quality healthcare for the patient. Consequently, this paper recommends the application of quality terms in healthcare and standards from quality and regulatory organizations as crucial antecedents of quality decision making and management practices to improve healthcare for patients.

Quality Terms in Healthcare

A number of studies, notably by Foley and Vale (2017) define quality healthcare as the extent to which health services can enhance “safe, effective, patient-centered, timey, efficient, and equitable” outcomes. Subsequently, five quality terms are discussed.

Value –Based Purchasing

Studies have associated value-based purchasing by nursing leaders with adequate staffing levels leading to increased retention, job satisfaction, productivity, and better outcomes (Lee et al., 2020). Thus, the Nurse leader can utilize data from the Hospital Value‐Based Purchasing (VBP) Program to determine how best to leverage on Medicare provider payment bonuses to encourage hospital administrators to improve performance in clinical processes, patient outcomes, patient experiences, and efficiency (Lee et al., 2020). Additionally, the Nurse leader can apply nursing-sensitive value-based purchasing by increasing the number of nurses, improving proficiency level, and certification of nursing staff (Kavanagh, Cimiotti, Abusalem & Coty, 2012).

Hospital Consumer Assessment of Healthcare Providers and System

To entrench quality in healthcare, the nurse leader should lead team members in implementing complaints obtained from the HCAHS survey Centers for Medicare and Medicaid Services (2018). Complaints from HCAHPS reports could be used to make decisions on whether to hire new nurses, how to schedule shifts and so on.

Quality and Safety Education for Nurses (QSEN)

Nursing leaders can enhance positive outcomes for patients by enrolling nursing staff into the Nurse leaders Quality and Safety Education for Nurses (QSEN) training program (LoBiondo-Wood, Haber & Titler, 2018).  The Leaders should also promote continuous improvement by recommending changes to the nursing training curriculum.

Plan, Do, Check, and Act

Nursing leadership is encouraged to utilize the PDCA to generate Early Warning Score (EWS) data as an evidence-based tool and a mechanism for early detection using quantitative data (Randhawa, Roberts-Turner, Woronick & DuVal, 2011). The Plan-do-check-act cycle (PDCA) is an iterative four-step blueprint for executing change. Nurse leaders could use the PDCA cycle knowledge to refine routine and repetitive tasks of nursing practice for greater patient outcomes.

Six Sigma

Comprehensive review of literature by Liberatore (2013) on application, process changes and outcomes, recommends that nursing leaders should instigate continuous improvement in process times, lead times, and affordable cost for patients.

Quality and/or Regulatory Organizations

An understanding of the intersection of national and federal agenda in healthcare by LoBiondo-Wood, Haber and Titler (2018) identify several federal and national-level organizations specifically devoted to advancement of quality, safety and population health through application of evidence.

Institute of Medicine (IOM)

To entrench quality in nursing care, nurse leader could organize trainings for staff to acquaint themselves with IOM requirements, namely, the standards diagnostic, therapeutic, and preventive services. Additionally, Nurse Leaders can strengthen partnerships with IOM to sustain a robust framework for the practicing evidence-based medicine, scientific discovery and technological innovation (LoBiondo-Wood, Haber & Titler, 2019). The IOM also equips nurses with up-to-date skills for provision of appropriate care for the right patient at the right time.

Joint Commission on Accreditation of Healthcare Organizations

A study by Pileggi et al. (2019) show that nurses can entrench quality outcomes for patients by applying performance metrics using joint commission on accreditation of healthcare organizations (JCAHO) indicators. In this regard, nurse leaders can proactively train nursing staff on “emerging quality and safety issues” in healthcare and appropriate mitigation measures.

Centers for Medicare and Medicaid Services

Nursing leaders should obtain regular “Overall Hospital Quality Star Ratings” a summary rating of hospital performance on quality parameters such as mortality, readmissions, safety, patient experience, efficient use of imaging, effectiveness of care, and timeliness of care (DeLancey et al., 2017).

Leapfrog

Proactive steps to improve quality of healthcare can be initiated by nurse leaders by studying patient safety data from Leapfrog Group. Accordingly, Armstrong (2019) delimits a 4 tier grading approach, A, B, C, D, or F on the basis of survey data. In this regard, Leapfrog data can be used to determine the quality of healthcare and to determine whether there is need for improvement.

Conclusion

In conclusion, important information which nursing leaders can use to improve quality of healthcare has been discoursed. Specifically, evidence from the surveyed literature has shown that evidence-based practices derived from quality terms in healthcare, and quality and regulatory organizations are integral to achievement of quality care for patients. As there are near-limitless opportunities for improvement, it is recommended that evidence-based practice should be escalated through more rigorous training of nurses in future.