Effective leadership and management in nursing

Quality and risk management are major issues in the current healthcare environment. Safety, quality and consumer satisfaction and outcomes are key elements of the healthcare system too. More and more time for all healthcare organizations is being spent determining the best way to meet customer expectations. Understanding the major concepts associated with quality, risk, and consumer relations will assist in developing the staff nurse role. Each health care organization is concerned with safe, quality, efficient, and cost effective care. Anyone of these variables cannot be overlooked in order to focus on one or few. Few consumers will want cost effective care that is not safe or of highest quality.


As you will recall from earlier reading, organizations are about structure, process and outcome. Quality improvement is a means to assess and measure on an ongoing systematic say how an organizations is meeting desired outcomes. Key concepts to understand regarding safety and risk in hospitals is based on Norma Accident and High Reliability Theory. High Reliable Organizations (HRO) are those that operate under the premise that something can go wrong, consequently they are always on alert to prevent error by avoiding complacency. Drifting into failure is a term well known to “high risk” professions such as healthcare and aviation. Often times deviation from the standard is seen and experienced and allowed to go on until eventually something catastrophic happens. It is important to not allow the establishment of deviation from what should be. Other safety measures include those associated with Just Culture and include learning from mistakes, reporting mistakes and treating mistakes in a non-punitive fashion. See journal articles listed for this module.


Six Sigma is a vision of quality, which equates to about 3.4 defects per million opportunities for each product or service transaction. Six Sigma is a methodology that strives for perfection. Sigma is a statistical term that measures how far a given process deviates from perfection. The central idea behind Six Sigma is that if you can measure how many “defects” you have in a process, you can systematically figure out how to eliminate them and get as close to “zero defects” as possible. To achieve Six Sigma Quality, a process must produce no more than 3.4 defects per million opportunities. An “opportunity” is defined as a chance for nonconformance, or not meeting the required specifications.


Quality improvement process has steps similar to nursing process. It involves steps to plan, implement and evaluate. Benchmarks serve as a basis for comparison of “best practice.” These benchmarks have been developed through research and evidence. Healthcare organizations use report cards and score cards to report criteria related to quality and safety.


Consumer relationships are crucial to the viability of any organization. There is a common saying that if a customer is satisfied with the service received from a company, he may not tell anyone, however, if a customer receives negative service, he tells at least 20 people. Think of examples that you have had. This principle relates to health care as well. Unhappy patients have many other choices, especially in urban areas. Patient outcomes and patient satisfaction are two different things. Patients may have negative outcomes and still be satisfied with the organization and care. There are a number of variables that influence this and one is customer relations.


1. Discuss the process of root cause analysis.  Who is involved in this process?

2. Give an example of a nurse sensitive outcome, defined by the American Nurses Association, and how it is used in your clinical setting.

3. Describe principles of high reliable organizations that you see in the healthcare setting

4. Describe the four components of just culture and how you think Just culture contributes to patient safety.

5. Discuss your experience with the process of reporting sentinel events in an organization. What error reporting mechanism is in place?

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