This comprehensive book organizes the components of quality and safety outcomes, within a framework developed by expert nurses. Such a framework is missing in existing books on quality and safety in health care, and the concepts of nursing and organizational outcomes are often overlooked. This book fills this gap by exploring and expanding the various features of the Quality Health Outcomes Model (QHOM) and its four main concepts of System, Client, Interventions, and Outcomes. Using a broad and comprehensive approach, the authors identify the most current empirical evidence and concepts in the nursing field to provide an up-to-date understanding of the QHOM’s four concepts and their interrelations. New concepts include (a) systems concepts of turbulence and complexity of workflow and use of the electronic health record to support clinical workflow; (b) client concepts of social determinants of health, health literacy, and chronicity; (c) intervention concepts of interprofessional practice, nursing care processes including unfinished care, and care coordination; (d) outcome concepts related to nursing and the organization in addition to patient outcomes that includes the patients’ experience.
The ideas, approaches, and evidence are provided by a team of experienced researchers, practitioners, and leaders. The author team presents an updated, state-of-art view of how system, client, and interventions affect client, nurse, and organizational outcomes.
This book will appeal to researchers, clinicians, and researchers interested in healthcare quality and in particular nurses and nursing students in administration, research, and practice.
Author(s): Marianne Baernholdt, Diane K. Boyle
Publisher: Springer
Year: 2021
Language: English
Pages: 282
City: Cham
Foreword
Contents
Contributors
Part I: Introduction
1: Overview of the Quality Health Outcomes Model
Introduction
Background of the Quality Health Outcomes Model
The Quality Health Outcomes Model
Components of the QHOM
System
Client
Interventions
Outcomes
Theoretical and Analytic Advantages of the QHOM
Use of the QHOM in the Literature
System
Client
Interventions
Outcomes
How This Book Is Organized
Summary
References
Part II: Context
2: Healthcare Policy
Introduction
Healthcare Policy Linkages to QHOM
Access to Care
Public Insurance Programs
Medicare
Medicaid
Employer-Sponsored Coverage
Marketplace
Healthcare Spending
Prospective Payment Systems and Managed Care
Pay-for-Performance Policies
Hospital-Acquired Conditions (HACs)
Hospital Readmissions Reduction Program (HRRP)
Medicare Hospital Value-Based Purchasing Program (HVBP)
Hospital-Acquired Condition Reduction Program (HACRP)
Quality Measurement
Other Policy Interventions
Professional Guidelines and Standards of Care
Health Information Technology
Workforce Development
Using Multilevel Policies to Manage the Opioid Crisis
Summary and Future Directions
References
3: The Nurse Workforce
Introduction
The Nurse Workforce: Context for the Quality Health Outcomes Model
Interplay of Nursing Supply and Demand at Various Levels of the Healthcare System
Supply
Nursing Education Programs
Personal Choices Influencing Entry and Exit from the Profession and Specialties
Geographical Mobility Regionally, Nationally, Internationally
Demand
Supply, Demand, Shortage, and Surplus at Various Levels of the Healthcare System
Supply, Demand, Shortage, and Surplus in Specific Settings
Acute Care Hospitals and Hospital Specialties
Subacute and Rehabilitation Settings
Long-Term Care
Community-Based Care
Other Settings
Managing Supply and Demand of the Nurse Workforce
Recruitment Efforts
Retention Efforts
Diversity Considerations
Age and Generational Differences
Nurse Education and the Entry to Practice Debate
Dealing with Impacts of Workforce-Related Regulatory Efforts Such as Minimum Staffing Ratios
The Future of the Nurse Workforce
References
Part III: System
4: The Nurse Work Environment
Introduction
Nurse Work Environment: Specific Linkages with the QHOM
System
The Nurse Work Environment
Joy in Work
Safety Culture
Incivility, Bullying, and Violence
Staffing
Measures of Components of the Nurse Work Environment
Measures of the General Nurse Work Environment
Measures of Joy in Work
Measures of Safety Culture
Measures of Incivility, Bullying, and Violence
Measures of Staffing
Considerations for Selecting NWE Measures
System Interventions
Magnet® Recognition
Pathway to Excellence® Recognition
Implications and Future Directions
Improving Joy in Work, Clinician Well-Being, and Resilience
Building a Stronger Safety Culture
Addressing the Quintuple Aim of Systemic Racism
References
5: Workflow, Turbulence, and Cognitive Complexity
Introduction
Workflow, Turbulence, and Cognitive Complexity: Specific Linkages with the QHOM
System Characteristics
Workflow
Workflow in Healthcare
Turbulence
Turbulence in Healthcare
Turbulence in the External Environment
Turbulence in the Internal Environment
Sources of Turbulence in Nurses’ Work
Interruptions
The Anatomy of an Interruption
Handoffs
Patient Turnover
Workarounds as a Sign of Turbulence
Client Characteristics
Cognitive Complexity
Visible and Invisible Work
Cognitive Workload
Cognitive Stacking
Client (Nurse) Outcomes
Work Stress
Cognitive Failure
Implications and Future Directions
References
6: Health Information Technology and Electronic Health Records
Introduction
Health IT: Linkages to the QHOM
Environmental Context of Healthcare Regulation in the USA
Important Health IT Regulatory Milestones
Structural Components of Health IT Established Under Meaningful Use
System Characteristics that Influence Health IT Adoption
Health IT Interventions
Quality Improvement Tools to Improve Structural Components of Health
The Project Charter
Plan-Do-Study-Act (PDSA) Cycles
Control Charts
Workflow Redesign to Optimize EHRs and Other Point-of-Care Technologies
Health IT Competencies
Technology Informatics Guiding Education Reform (TIGER)
Client
Outcomes
Summary
References
Part IV: Client
7: Health Literacy and Social Determinants of Health
Introduction
Health Literacy: Specific Linkages to the QHOM
Client
Interventions
Health Literacy Interventions Focused on the Client
Health Literacy Universal Precautions
Role of Health Literacy in Client Engagement, Empowerment, and Activation
System
Health Literacy Interventions Addressing the System
Fostering Health-Literate Healthcare Organizations
System Engagement of Community in Health Literacy
Outcomes: Health Literacy Impact Upon Quality and Safety
Individual Outcomes
System/Organization Outcomes
Community/Group Outcomes
Implications and Future Directions
References
8: Chronicity
Introduction
Chronicity: Linkages to the QHOM
Client
Client Characteristics
Health and Social Experiences
Demographics
Mental Health
Social Determinants
Medical/Physical Health
Interventions
Chronicity Interventions Focused on the Client
Self-Management Support
Care Coordination
Prevention
Chronicity Interventions Focused on the System
Chronicity Interventions Within Healthcare Organizations
Chronicity Interventions Across Municipalities
Implications and Future Directions
References
Part V: Interventions
9: Nursing Care Processes
Introduction
Nursing Care Processes: Linkages to QHOM
The Essence of Nursing Interventions
The Complexity of Nursing Interventions
Example: Rapid Response Teams
System Characteristics’ Effect on Nursing Interventions
Unfinished Nursing Care
Examples of Nursing Interventions
Surveillance
System-Level Interventions to Support Surveillance
Measuring and Evaluating Surveillance Interventions
Symptom Management
System-Level Interventions to Support Symptom Management
Measuring Symptom Management
Implications and Future Directions
References
10: Interprofessional Practice and Education
Introduction
Interprofessional Practice: Linkages with the QHOM
Interprofessional Practice and Education Within a Complex System
What Is Interprofessional Practice?
Contrasting Interprofessional Education and Interprofessional Practice
Science that Informs IPP and IPE
Characteristics Important for Interprofessional Practice
Organizational Culture
Interprofessional Practice Interventions
Interprofessional Education
Team Training
System Redesign
Example of an IPP Intervention in One Healthcare System
Summary and Future Directions
References
11: Care Coordination
Introduction
Care Coordination: Linkages to the QHOM
System Characteristics of Care Coordination
Clinician Perspective
Organizational Perspective
Client
Care Coordination Interventions
RN Clinical Processes: Direct Interventions
RN Clinical Processes: Indirect Interventions
Outcomes of Care Coordination
Outcome Measures for RN Care Coordination
Summary
References
Part VI: Outcomes
12: Client and Family Outcomes: Experiences of Care
Introduction
Person-Centered Care: Linkages with the QHOM
Person-Centered Care Interventions
Micro-level Interventions
Macro-level Interventions
Client and Family Characteristics
System Characteristics
Outcomes Associated with Person-Centered Care Interventions
Client and Family Outcomes
System Outcomes
Challenges Measuring Person-Centered Care
PCC Measures
Methodological Challenges
Implications and Future Directions
References
13: Nurse Outcomes: Burnout, Engagement, and Job Satisfaction
Introduction
Nurse Outcomes: Linkages with the QHOM
Nurse Outcomes
Predictors of Job Satisfaction and Turnover
Burnout and Engagement
Interventions: Client (Nurse)
Self-Knowledge
Talent and Passion
Self-Awareness
Self-Control
The Interpersonal Circumplex Model
Interventions: System
Magnet Recognition Program
Example of Nurse Outcome Program of Research
Implications and Future Directions
References
14: Organizational Outcomes: Financial and Quality Measures
Introduction
Healthcare Organizational Outcomes: Specific Linkages with the QHOM
Evolution of Policies and Programs to Promote Safer Patient Care
Quality and Safety Measurement
Quality and Safety Measure Development
Federal Reimbursement Accountability Initiatives
Nonfederal Quality Improvement Initiatives
ANCC Magnet Recognition Program
ANCC Pathway to Excellence Program
The Leapfrog Group
Hospital Organizational Outcomes
Improvement in Quality and Safety Measures
Reimbursement Outcomes
Implications and Future Directions
References
Part VII: Closing
15: The Way Forward
Introduction
The QHOM in the Context of Quality and Safety Reports
The Institute of Medicine
Reports Focused on Nurses
Future Directions
References
