Transforming nursing through knowledge

Quality Care: Leadership

Leadership - is a shared responsibility with other nursing leaders and reflects both current and future decision making related to strategic and operational issue.
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    Nursing Quality Indicators for Reporting and Evaluation (NQuIRE) is the first international quality improvement initiative of its kind consisting of a database of quality indicators derived from recommendations within RNAO’s clinical Best Practice Guidelines (BPGs).

    NQuIRE collects, analyzes and reports comparative data on nursing-sensitive indicators reflecting the structure, process and outcomes of care arising from BPG implementation in organizations participating in RNAO’s Best Practice Spotlight Organization® (BPSO®) designation. These health-care organizations, which exist across Canada, the US, Spain, Chile, Colombia, and Australia, will be able to use NQuIRE data to link evidence-informed nursing practice with quality-of-care outcomes.

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    Ontario’s nurses call on government and stakeholders to collectively strengthen our publicly-funded, not-for-profit health system and make it more responsive to the public’s needs, easier to navigate and more efficient and cost-effective. To make this happen, the health system must be anchored within primary care to advance primary health care for all through: health promotion, disease prevention, chronic disease management/prevention and mental health care. Equally important are addressing social/environment determinants of health and changes that enable nurses and all other regulated health professionals to work to their full scope of practice, a commitment to reducing structural duplication, and advancing system integration and alignment.

    This white paper presents a model that advances a robust foundation for community care and improves integration between all health sectors through a single health system planner and funder – the LHINs as maturing system structure – and anchoring the health system in primary care. Specifically, the paper provides an overview of the ECCO model to inform and evolve strategies to ensure timely access to Ontario’s health system, improve client experience and outcomes, and deliver comprehensive services in a cost-effective and seamless manner.

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    Ensuring high quality, integrated care for all patients, clients and residents should be the goal of everyone involved in delivering health care in Ontario. This is a principle embedded in the Excellent Care for All Act (ECFAA), and one that is shared within broader system priorities and initiatives. 
    ECFAA, passed in June 2010, laid the foundation for a health care system that is patient-centered, focused on accountability and transparency, and committed to improving the quality of care Ontarians receive. The government’s commitment to quality improvement applies to all health care sectors, bringing us together to share in the commitment to quality health care where the needs of patients/clients/residents come first. 
    While ECFAA provided the foundation for excellence, Ontario’s Action Plan for Health Care, which was released in January 2012 by the Minister of Health and Long-Term Care, built on this foundation, providing an ambitious blueprint for health system transformation that involves all health care partners and providers. 
    System-wide quality improvement is the vision that the Ministry of Health and Long-Term Care (ministry) provides for all health care sectors, using the Quality Improvement Plan (QIP) as an enabler for this change. 
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    In its final report, A Nursing Call to Action, the Commission outlined a nine-point action plan to drive better health, better care and better value in Canada’s health-care system. The first step in this plan specified 
    the need to establish Canada as a leader on five key health outcomes within the next five years.
    The following report sets forth an evidence-informed, expert-driven and publicly informed process by which to carry out the National Expert Commission’s proposed plan of action. It directly reflects the set 
    of transformation principles outlined by CNA and the Canadian Medical Association (and endorsed by many system partners) in Principles to Guide Health System Transformation in Canada


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    Health Outcomes for Better Information and Care: Acute and Home Care in Ontario 2013

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    The Staff Mix Decision-making Framework for Quality Nursing Care is a comprehensive and evidence-informed resource presenting a systematic approach to staff mix decision-making that can be used in all clinical practice settings. Decisions concerning staff mix must reflect nurses’ scope of practice and unregulated care providers’ (UCP) scope of employment and must conform to legislation, professional standards and organizational policies. Administrators and researchers are encouraged to use outcome measurement data in a rigorous manner to inform decision-making regarding safe and effective staffing practices.
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    This literature synthesis strengthens our understanding of the elements that influence staff mix decision-making, including patient, provider and organizational factors. In addition, it provides further evidence to support the evaluation framework (CNA et al., 2005) that is broadly structured using those three components. While some progress has been made toward the development and implementation of tools and processes to inform staff mix decision-making, substantial gaps in this area remain. In effect, this represents the ‘uptake’ or ‘utilization’ of the research linking nursing staff mix to clinical outcomes. 
    Overall, the evaluation framework provides one organizing model that settings can use to apply staffing research to practice environments. While researchers continue to produce literature in this field that contains variable findings, the results can be used to broadly inform decisions around nurse staffing. As such, administrators and researchers must continue to measure outcomes in a meaningful and consistent manner to enhance evidence regarding safe and effective nurse staffing practices.
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    Presents a reporting template with a list of priority nursing-sensitive inputs, processes (throughputs), and outcomes for your consideration. The template provides a core set of quality indicators that demonstrate the nursing contribution to care. Research from major nursing indicator projects and literature reviews were used to inform the development of this template. Based on the evidence, a core set of quality indicators is proposed that includes both process indicators, which measure aspects of nursing care such as assessment and interventions, and nursing-sensitive outcome measures. The template also includes indicators which measure the structure of care as indicated by data on the supply and skill level of nursing staff, work intensity, and client characteristics. 
    The template includes quality indicators that are applicable to in-patient settings (such as acute care and community hospitals), those that are applicable to public health, and indicators common to both health contexts.
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    This report analyzes results from the first year in which LTC home leaders submitted QIPs. The purpose of this review is to:
    Acknowledge the commitment of LTC leaders to improving quality;
    Analyze the number and type of priorities identified by LTC home leaders;
    Identify any challenges that LTC home leaders encountered during the development of their QIPs; and
    Provide information and guidance to help LTC home leaders improve their next QIPs and set the stage for future success.
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    This study focuses on the implementation and evaluation of the Forecasting Future Workforce Demand Tool. It was hypothesized that the implementation of the Tool would enable hospitals to enter historical workforce data to create one to five year forecasts for proactive HHR planning and strategy development.