Quality and Sustainability Paper: Part 1

Quality and Sustainability Paper: Part 1

Healthcare organizations and professionals face multiple challenges exacerbated by intricacies in the healthcare sector and the overarching demands for timely, convenient, safe, and efficient care services. According to Dixon (2021), providing quality care is a complex endeavor that prompts health organizations to establish long-term agendas consisting of careful stewardship, evidence-based practices, effective organizational leadership, priorities, and care quality and patient safety measures. Other prerequisites for quality care delivery include cultivating a culture of safety and nursing excellence, incorporating innovation and creativity into clinical practices, staff improvement through rewards and professional development opportunities, and setting ethical and professional standards for practice. Amidst the rationale for safeguarding patient safety and improving care quality, this paper elaborates on quality and safety measures, identifies barriers and facilitators of quality care delivery, and describes a specific contemporary quality and safety issue measured at the healthcare entity, as well as explains the issue’s applicability to nursing practice. Finally, the paper provides an in-depth discussion about the current quality and safety program for addressing the selected safety issue and the specific variables for tracking the improvement of the healthcare quality and safety program’s outcomes.

Defining Quality and Safety Measures, their Relationship, and Role in Nursing Practice

Care quality and safety are inseparable concepts that underpin nursing practices and form the basis of ethical and professional standards for healthcare professionals. Although the two aspects represent the overarching objectives of nursing practice, there needs to be more consensus regarding their definition. The World Health Organization [WHO] (2022) defines care quality as ‘the degree to which health services for individuals and populations increase the likelihood of desired health outcomes.” In all clinical contexts, the primary health outcomes include alleviating pain, reducing delays, improving patients’ health and wellness, ensuring comfort and satisfaction, and preventing adverse events that can compromise or threaten patients’ health goals. Consequently, it is possible to define the quality of care by using various dimensions that form the basis of current care delivery mechanisms.

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Often, healthcare organizations use the Institute of Medicine’s (IOM) framework to define and explain the quality of care. The Agency for Healthcare Research and Quality [AHRQ] (2022) identifies six dimensions central to the IOM’s definition of care quality: safety, effectiveness, equity, efficiency, timeliness, and patient-centered. In this sense, the safety dimension entails all concerted efforts to prevent and avoid harm to patients emanating from care interventions intended to benefit them (AHRQ, 2022). Secondly, care effectiveness entails incorporating the widespread role of scientific knowledge into clinical practices and avoiding care interventions likely to constrain or conflict with the beneficence ethical principles. Care timeliness encompasses eliminating or reducing delays in care delivery.

Similarly, process efficiency denotes a culture of sustainable resource utilization to avoid waste and losses. Finally, patient-centeredness and equity involve respecting and responding to patients’ needs, health preferences, and values while reducing disparities in care access, affordability, and utilization (AHRQ, 2022). The six dimensions of quality care are inseparable and essential components of continuous quality improvement (CQI) initiatives.

Quality and safety measures and their roles

Care quality and safety measures are primarily the nursing-sensitive quality indicators (NSQI) that fall under the three components of the Donabedian model: process, structure, and outcome measures. Oner et al. (2020) define NSQI as “the criteria for changes in health status that nursing care can directly affect” (p. 1006). These change elements provide opportunities for objective assessment, continuous improvement, and practical evaluation of care quality and organizational performance. Based on the Donabedian model, structural indicators or care quality measures encompass multiple subcomponents, including nursing staffing characteristics, such as nurse staff qualifications, numbers, staff ratios, and levels. Also, unique hospital characteristics like patient acuity, turnover, healthcare professionals’ autonomy, and work environment are ideal structural aspects that can facilitate or undermine care quality and safety (Oner et al., 2020, p. 1007). The rationale for evaluating the structural indicators of care quality and safety is to identify organizational barriers and facilitators to quality care delivery.

Procedural indicators and measures of care quality and safety focus on mechanisms of care delivery that enable healthcare professionals to achieve the desired outcomes of nursing practices. Examples of these indicators are pain management interventions and procedures, treatment approaches, the culture and levels of patients’ education, and activities for skin integrity maintenance (Oner et al., 2020). Loopholes in these quality indicators can signify poor quality care delivery and undermined patient safety.

Finally, outcome measures are ideal for unearthing how the organization prevents and avoids adverse events that undermine patient safety and well-being while receiving care interventions. Also, these indicators accommodate nurse-focused issues that affect care delivery mechanisms. According to Oner et al. (2020), outcome measures of care quality and safety include nurse job satisfaction, burnout, nosocomial infections, mortality rates associated with preventable causes or events, patient falls, falls with injury, and pressure ulcers. Since outcome measures reflect the effects and impacts of nursing practices on the patient’s health status, they represent the gold standards for measuring care quality and safety beyond structural and procedural indicators.

Barriers to Healthcare Quality and Safety

Constraints and deficiencies in structural and procedural measures represent barriers to quality care delivery and patient safety. According to West et al. (2021), high-quality care is profound in ensuring patient satisfaction and achieving outcomes for patients requiring continuous maintenance. Also, quality care and mechanisms for safeguarding patient safety are vital in improving trust among healthcare professionals and patients. However, healthcare organizations grapple with various barriers to effective and quality care delivery, including a need for more resources, constrained clinical infrastructure, and ineffective staff development approaches. West et al. (2021) contend that understaffing contributes to limited human resource capacity to provide quality care and exacerbates other issues, including burnout, care delays, and stress among healthcare professionals. Poor facility infrastructure cuts across various aspects, including ergonomic constraints, spacing issues, overcrowding, lack of medication management systems, equipment, and a poorly-built environment.

Infrastructural constraints affect all elements of care delivery by limiting the organization’s capacity to provide care and exposing patients and healthcare professionals to safety threats (West et al., 2021). Finally, ineffective staff development approaches undermine quality care delivery by depriving healthcare professionals of opportunities to advance their skills, knowledge, and competencies consistent with the prevailing demands. Flawed professional development interventions include inadequate skill training, limited opportunities for networking, and understaffing.

These infrastructural and procedural deficiencies affect care quality and patient safety, prompting healthcare organizations to capitalize on various facilitators for quality care delivery. According to Cowie et al. (2020), facilitators for quality care and patient safety include supportive leadership, building staff capacity through adequate training, mentoring, supervision, creating a supportive culture that supports change, developing partnerships with other healthcare stakeholders to ensure accountability of roles and responsibilities, and installing advanced technologies and other appropriate infrastructure to facilitate care delivery. These aspects can address barriers to quality care delivery and patient safety.

Identifying a Healthcare Entity

ADH (hospital initials) is a non-profit health system affiliated with Seventh-day Adventists. This hospital system has provided quality care to a highly-diverse patient population since 1973. The ADH operates 50 healthcare facilities across nine states, making it one of the largest non-profit health systems in the United States. Regarding organizational capacity, ADH-affiliated facilities have over 8000 licensed beds and 1200 outpatient settings that serve approximately 5 million patients annually.


Contemporary Quality and Safety Issues

Emergency calls and management systems for cardiac arrest are vital in ensuring patient safety and saving lives. Patients grappling with emergency conditions like cardiac arrest often require timely and coordinated care. As a result, the “code blue (CB)” intervention presents an ideal strategy for alerting the emergency response team of cases of cardiorespiratory arrests. According to Monangi et al. (2018), using color codes remains popular in nursing to ensure timely communication. In code blue, alerts on events of cardiorespiratory arrests prompt early interventions, including defibrillation, cardiopulmonary resuscitation (CPR), and advanced care to ensure the patient’s survival (Monangi et al., 2018). It is possible to consider cardiopulmonary care as a measure of care quality by assessing the level of communication during cardiac arrests and recording mortality rates of cardiac arrests.

Current Quality and Safety Program

ADH has a comprehensive framework for treating cardiac conditions. The unconditional care initiative focuses on various aspects of quality cardiopulmonary care, including partnerships with reputable cardiac card specialists, innovative treatments, onsite Code STEMI teams, catheterization staff, and a wide range of surgical options. Other interventions for improving patients’ cardiovascular health include risk assessments and regular screening of daily physical exercise, patient education on a healthy diet, enabling patients to understand the warning signs, and providing emotional and spiritual care (AdventHealth Cardiovascular Institute, n.d.). Although these interventions are consistent with the need to reduce mortality rates and improve patient safety, the organisation requires a plan for communication during emergencies, such as cardiac arrest, to eliminate delays, enhance response mechanisms, and save lives. The code blue alert initiative could be a significant change in bolstering organizational interventions for responding to emergency cardiovascular care needs and events.

Specific Variables for Tracking Improvement

Progress tracking is essential in promoting continuous quality improvement. According to Seelbach & Brannan (2022), continuous quality improvement entails using tools and processes to identify and assess strengths and barriers to improved outcomes. Improvement tracking for the code blue program’s outcomes entails various variables and measures, including the number of patients who succumb to cardiopulmonary issues, the level of communication among emergency care teams, nurse job satisfaction, the number of reported cases of shock or cardiac arrest, and post-operative pain management interventions. Also, staffing needs and qualifications, including experience, education, and number, can influence the implementation and progress of the code blue initiative. These variables fall under the structural, procedural, and outcome measures of care quality and safety.


Care quality and safety are interrelated concepts that represent the primary goals of healthcare organizations. In current healthcare settings, care quality entails six dimensions: safety, efficiency, effectiveness, timeliness, patient-centeredness, and equity. As a result, safety is a profound aspect of quality care. Healthcare organizations can measure care quality and safety using structural, procedural, and outcome measures, including nurse staffing needs, pain management interventions, falls, mortalities, and nosocomial infections. These quality indicators provide opportunities for continuous quality improvement and objective assessment. As ADH implements the code blue program, it is possible to assess the program’s progress by using various variables of structural, procedural, and outcome measures, including cardiopulmonary-related diseases, the level of communication among emergency care teams, nurse job satisfaction, the number of reported cases of shock or cardiac arrest, and post-operative pain management interventions.


AdventHealth Cardiovascular Institute. (n.d.). Cardiovascular and thoracic programs. Retrieved January 13, 2023, from https://cfl.adventhealthcardiovascularinstitute.com/programs

Agency for Healthcare Research and Quality. (2022). Six domains of health care quality. https://www.ahrq.gov/talkingquality/measures/six-domains.html

Cowie, J., Nicoll, A., Dimova, E. D., Campbell, P., & Duncan, E. A. (2020). The barriers and facilitators influencing the sustainability of hospital-based interventions: A systematic review. BMC Health Services Research, 20(1). https://doi.org/10.1186/s12913-020-05434-9

Dixon, J. (2021). Improving the quality of care in health systems: Towards better strategies. Israel Journal of Health Policy Research, 10(1). https://doi.org/10.1186/s13584-021-00448-y

Monangi, S., Setlur, R., Ramanathan, R., Bhasin, S., & Dhar, M. (2018). Analysis of functioning and efficiency of a code blue system in a tertiary care hospital. Saudi Journal of Anaesthesia, 12(2), 245. https://doi.org/10.4103/sja.sja_613_17

Oner, B., Zengul, F. D., Oner, N., Ivankova, N. V., Karadag, A., & Patrician, P. A. (2020). Nursing‐sensitive indicators for nursing care: A systematic review (1997–2017). Nursing Open, 8(3). https://doi.org/10.1002/nop2.654

Seelbach, C., & Brannan, G. (2022). Quality management. StatPearls. https://www.statpearls.com/ArticleLibrary/viewarticle/28143

West, R. L., Lippman, S. A., Twine, R., Maritze, M., Kahn, K., & Leslie, H. H. (2021). Providers’ definitions of quality and barriers to providing quality care: a qualitative study in rural Mpumalanga Province, South Africa. Journal of Global Health Science, 3(1). https://doi.org/10.35500/jghs.2021.3.e1

World Health Organization. (2022). Quality of care. https://www.who.int/health-topics/quality-of-care#tab=tab_1


Appendix A: Barriers and Facilitators of Quality and Safety

Barriers Facilitators/Solutions
Poor health infrastructure ·         Developing partnerships and collaborations with other healthcare institutions to enhance institutional capacity

·         Ensuring resource accountability

·         Investing in advanced care delivery infrastructure

Understaffing and nurse shortages ·         Developing an employee retention plan

·         Transition planning

·         Employee retention and motivation

Inadequate interventions for staff development ·         Adequate skill training

·         Increased opportunities for networking

·         Supporting interventions for professional development, including strengthening the role of academic advancement and research.

·         Supporting evidence-based practice

 “This Order is for a Friend”

This assignment will be completed in two parts, which will be synthesized into a final paper.

The purpose of this assignment is to investigate a quality and/or safety issue in a health care entity. You will use the issue and health care entity that you select in this assignment for Part 2 of the paper and for the sustainability assignments. You may use an issue identified at the practice site in your DPI Project.

General Guidelines:

Use the following information to ensure successful completion of the assignment:

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Doctoral learners are required to use APA style for their writing assignments.
This assignment requires that you support your position by referencing six to eight scholarly resources. At least three of your supporting references must be from scholarly sources other than the assigned readings.
Write a paper (1,500-1,750 words) discussing the role of quality or safety in nursing practice. Include the following:

In your own words, define quality and safety measures and describe their relationship and role in nursing practice today.
Create a table that identifies three barriers, and three facilitators or methods for addressing the barriers, in today’s health care that impact both patient outcomes and organizational outcomes. Evaluate two of the barriers and provide solutions for how health care organizations can overcome them. Describe two of the facilitators or methods and explain how the facilitators or methods will assist overcoming or reducing barriers. Attach the table as an appendix to your paper.
Identify a health care entity. Provide an overall description of this entity without using the real name (e.g., location, size, profit or nonprofit, years in operation). In addition to not using the name of the health care entity, do not use the name of any person described.
Select a specific contemporary quality and/or safety issue that is measured at the health care entity and explain how that measure is applied in nursing practice. You will use this selected issue for all quality and sustainability assignments.
Describe the current quality and/or safety program the health care entity has in place to address the quality and/or safety issue you selected. Describe the key quality measures or components currently used to analyze the health care program’s outcome. Discuss what is working and what is not working.
Summarize the specific variables used to track improvement of the health care quality and/or safety program’s outcome.


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