Deborah Keller, RN, BSN, CMCN


Last week I attended a two-day refresher course then sat for the CPHQ exam the following day.  Of course, I learned (and re-learned) a lot related to the development and management of quality programs from effective team management to distributing information to internal and external stakeholders.  I also took out my pencil and dusted off some memories of college statistics to analyze data to identify best next steps.  While these “how to” exercises were certainly beneficial, they are not what I found to be the most valuable information presented.

The area that most resonated with me was the shift from “old school” QA which focused on identifying people who were not following a process and often went so far as to looking for someone to blame for an untoward patient outcome.  I can recall my earliest days of floor nursing when the QA nurses would come to a nursing staff meeting to reveal to us what the latest QA project was and what the consequences would be if we did not fill out a certain data collection tool or document something a certain way.  What I don’t remember is ever being told the why we need to improve something and how the QA project would accomplish improvement.  I also don’t remember getting analytical feedback on what data was collected.  Certainly, as a staff nurse back when, I was never invited to sit on a team working to develop and roll out a quality initiative.

Sitting in a room with quality professionals that spanned quite a spectrum (nurses, social workers, therapists, etc.) what was discussed was a culture of safety and process improvement.  In a culture of safety multidisciplinary team members are involved in the development and execution of quality initiatives.  The focus of these programs is the identification of what is broken and fixing it, not finding who is at fault.

Utilizing a Continuous Quality Improvement (CQI) process such as Plan, Do, Study, Act (PDSA), the organization strives to continuously look at systems and processes that have resulted in outcomes that were less than what is desired.  Root cause analysis is used to leverage sentinel events as opportunities to affect proactive changes.  Again, the focus being fixing those systems and processes that led to occurrence of the sentinel event.   In addition to retrospective analytical tools, organizations also use proactive CQI processes as well.  One example is the Failure Mode Effects Analysis (FMEAC) in which all possible failure points are proactively identified and weighted.  Once weighted for priority, preventive measures are identified and added to the product or process to prevent the failure from occurring.  These are just a few of the examples of options.

I would encourage leaders to take a hard look at your organization and ask yourself if you are leading a culture of safety.  Are you constantly reevaluating your systems and processes?  Does your team feel safe reportin a near miss?  Does your team feel included in your quality program?  Are you fully supportive of your quality team?  If not, maybe you would enjoy a refresher as much as I did.