National Quality Strategy: Where Do Nurses Fit?
National Quality Strategy: Where Do Nurses Fit?
The definition of quality healthcare, its accurate measurement, and its effective management is nebulous and constantly evolving. Even the most respected and knowledgeable experts cannot come to consensus on exactly what quality means. Levels of measurement, as well as questions of whom, how, and when to measure are topics of continual deliberation. These discussions occur at multiple levels through councils, committees, workgroups, task forces, and expert panels. Many policy-related decisions these groups make affect nurses and nursing care. All of them affect how patients receive or engage in healthcare. This article discusses the National Quality Strategy by offering a description and history of the quality conversation, including federal advisory committees and quality measurement data standards. There are several gaps in the quality conversation to which nurses could contribute valuable insights. The authors describe ways that nurses can engage in the national quality agenda. The article concludes with a call to action to encourage nurses to take a larger role in driving the National Quality Strategy.
The definition of healthcare quality, its accurate measurement, and its effective management is nebulous and constantly evolving. Even the most respected and knowledgeable experts cannot come to consensus on exactly what quality means (Beattie, Shepherd, & Howieson, 2013; Wharam & Sulmasy, 2009). Levels of measurement, as well questions of whom, how, and when to measure are topics of continual discussion at multiple levels through councils, committees, workgroups, task forces, and expert panels.
At the federal level, the U.S. Department of Health and Human Services (HHS) convenes federal advisory committees (FACAs) to inform, advise, and guide decisions about regulation, implementation, and enforcement of legislation (U.S. Government Services Administration [GSA], 2012). As committees form, or as vacancies on existing committees occur, HHS publishes requests for participation in FACAs in the Federal Register. Typically, FACA participation is open to the general public. The agency or contractor seeking participation will detail recommended backgrounds and time commitments in the request (GSA, 2012). An individual wanting to participate may submit his/her information independently; however, professional organizations like the American Nurses Association (ANA) often submit letters of support for nominees with particularly appropriate backgrounds or experiences. For instance, ANA supported the nominations of Norma M. Lang, PhD, RN, FAAN, FRCN, LL to the Health Information Technology Policy Committee Quality Measures Workgroup and Patricia Flatley Brennan, RN, PhD, FAAN, FACMI to the Food and Drug Administration Safety Innovation Act Workgroup. Participation by nurse experts ensures that decisions and recommendations coming from these committees include nursing perspectives and nurses' needs.
Presently, FACAs convened by the Centers for Medicare and Medicaid Services (CMS), the Office of the National Coordinator for Health IT (ONC), and the National Quality Forum (NQF—a HHS contractor) are engrossed in decision making about the implementation of the Patient Protection and Affordable Care Act (PPACA or Health Reform; PL 111–148) (U.S. Government Printing Office, 2010) and meaningful use (MU) under the Health Information Technology for Economic and Clinical Health (HITECH) Act (Blumenthal & Tavenner, 2010; ONC, 2012). Health reform affects nearly every part of the U.S. healthcare system (PL 111–148). Of most significance to this article, the PPACA outlines many of the criteria and subsequent incentives paid to eligible professionals (e.g., physicians, nurse practitioners) and hospitals for improving the quality of healthcare delivered in the United States. The purpose of incentives is to focus clinicians' attention on improving care (Stone et al., 2010; Werner, Kolstad, Stuart, & Polsky, 2011).
The HITECH Act establishes criteria for MU, or the set of standards used to incentivize eligible professionals, facilities, and critical access hospitals to use electronic health records (EHRs) in a meaningful way (P.L. 111–5; Blumenthal, 2010). The purpose of MU incentives is to increase the speed of EHR adoption and healthcare improvement. MU of EHRs provides three main benefits: 1) to improve completeness and accuracy of health information; 2) to improve accessibility and sharing of information; and 3) to facilitate patient engagement by encouraging clients to access their own health information electronically and securely over the Internet; share that information with their families; and more actively participate in their own care (ONC, 2012).
Members of ANA's Nursing Practice and Policy Department note that very few nurses engage in discussions that may greatly impact their profession; however, policymakers depend on stakeholder input to make decisions about how to plan, implement, and enforce laws and regulations (Dr. Maureen Dailey, personal communication, July 18, 2013). This introductory information about quality and MU is intended to provide context for readers to be conversant on this important and fast-moving topic. This article will outline the quality conversation and some of its participants; reveal some of the perceived gaps in the conversation into which nursing could contribute valuable insights; and hopefully prompt nurses to volunteer to participate in committees, comment on regulations, or otherwise engage in the discussion. Nurses are clinicians and caregivers for children, families, and a diverse array of patients. Decision makers value their input.
Abstract and Introduction
Abstract
The definition of quality healthcare, its accurate measurement, and its effective management is nebulous and constantly evolving. Even the most respected and knowledgeable experts cannot come to consensus on exactly what quality means. Levels of measurement, as well as questions of whom, how, and when to measure are topics of continual deliberation. These discussions occur at multiple levels through councils, committees, workgroups, task forces, and expert panels. Many policy-related decisions these groups make affect nurses and nursing care. All of them affect how patients receive or engage in healthcare. This article discusses the National Quality Strategy by offering a description and history of the quality conversation, including federal advisory committees and quality measurement data standards. There are several gaps in the quality conversation to which nurses could contribute valuable insights. The authors describe ways that nurses can engage in the national quality agenda. The article concludes with a call to action to encourage nurses to take a larger role in driving the National Quality Strategy.
Introduction
The definition of healthcare quality, its accurate measurement, and its effective management is nebulous and constantly evolving. Even the most respected and knowledgeable experts cannot come to consensus on exactly what quality means (Beattie, Shepherd, & Howieson, 2013; Wharam & Sulmasy, 2009). Levels of measurement, as well questions of whom, how, and when to measure are topics of continual discussion at multiple levels through councils, committees, workgroups, task forces, and expert panels.
At the federal level, the U.S. Department of Health and Human Services (HHS) convenes federal advisory committees (FACAs) to inform, advise, and guide decisions about regulation, implementation, and enforcement of legislation (U.S. Government Services Administration [GSA], 2012). As committees form, or as vacancies on existing committees occur, HHS publishes requests for participation in FACAs in the Federal Register. Typically, FACA participation is open to the general public. The agency or contractor seeking participation will detail recommended backgrounds and time commitments in the request (GSA, 2012). An individual wanting to participate may submit his/her information independently; however, professional organizations like the American Nurses Association (ANA) often submit letters of support for nominees with particularly appropriate backgrounds or experiences. For instance, ANA supported the nominations of Norma M. Lang, PhD, RN, FAAN, FRCN, LL to the Health Information Technology Policy Committee Quality Measures Workgroup and Patricia Flatley Brennan, RN, PhD, FAAN, FACMI to the Food and Drug Administration Safety Innovation Act Workgroup. Participation by nurse experts ensures that decisions and recommendations coming from these committees include nursing perspectives and nurses' needs.
Presently, FACAs convened by the Centers for Medicare and Medicaid Services (CMS), the Office of the National Coordinator for Health IT (ONC), and the National Quality Forum (NQF—a HHS contractor) are engrossed in decision making about the implementation of the Patient Protection and Affordable Care Act (PPACA or Health Reform; PL 111–148) (U.S. Government Printing Office, 2010) and meaningful use (MU) under the Health Information Technology for Economic and Clinical Health (HITECH) Act (Blumenthal & Tavenner, 2010; ONC, 2012). Health reform affects nearly every part of the U.S. healthcare system (PL 111–148). Of most significance to this article, the PPACA outlines many of the criteria and subsequent incentives paid to eligible professionals (e.g., physicians, nurse practitioners) and hospitals for improving the quality of healthcare delivered in the United States. The purpose of incentives is to focus clinicians' attention on improving care (Stone et al., 2010; Werner, Kolstad, Stuart, & Polsky, 2011).
The HITECH Act establishes criteria for MU, or the set of standards used to incentivize eligible professionals, facilities, and critical access hospitals to use electronic health records (EHRs) in a meaningful way (P.L. 111–5; Blumenthal, 2010). The purpose of MU incentives is to increase the speed of EHR adoption and healthcare improvement. MU of EHRs provides three main benefits: 1) to improve completeness and accuracy of health information; 2) to improve accessibility and sharing of information; and 3) to facilitate patient engagement by encouraging clients to access their own health information electronically and securely over the Internet; share that information with their families; and more actively participate in their own care (ONC, 2012).
Members of ANA's Nursing Practice and Policy Department note that very few nurses engage in discussions that may greatly impact their profession; however, policymakers depend on stakeholder input to make decisions about how to plan, implement, and enforce laws and regulations (Dr. Maureen Dailey, personal communication, July 18, 2013). This introductory information about quality and MU is intended to provide context for readers to be conversant on this important and fast-moving topic. This article will outline the quality conversation and some of its participants; reveal some of the perceived gaps in the conversation into which nursing could contribute valuable insights; and hopefully prompt nurses to volunteer to participate in committees, comment on regulations, or otherwise engage in the discussion. Nurses are clinicians and caregivers for children, families, and a diverse array of patients. Decision makers value their input.
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