Leadership 1

Leadership and Management: Foundations and Background

• Institute of Medicine (IOM)
• Independent nonprofit agency
• Provides unbiased and reliable advice on health and healthcare
• National Academy of Medicine (NAM)
• Improve population health using science, health equity, and trusted advice

Promote healthcare quality and client protection

Consumer Bill of Rights

To Err is Human (IOM)

• Medical errors leading cause of unexpected injury and death in United States' healthcare settings
• Domains of quality
• Patient safety practices
• Practice consistent with current medical knowledge
• Customer-specific values and expectations

Quality and Safety Education for Nurses (QSEN) Core Competencies

ProfessionalismEvidence Based PracticeInformatics

Patient Centered CareTeamwork and CollaborationQuality and Safety

Patient-Centered Care

Fundamental elements

• Advocacy
• Empowerment
• Self-management
• Health literacy
• Cultural competence

• Patient is the cource of control and full partner
• Respect patient preferences, values, and needs

Teamwork and Collaboration

• Function effectively within interdisciplinary and multidisciplinary teams
• Open communication, mutual respect, shared decision-making
• Collaborate with teams, patient, and family

COMMIUNICATION ERRORS LEAD TO MEDICAL ERRORS

Evidence-Based Practice (EBP)

• Six steps to integrate evidence into practice
• Based on the most current and best available knowledge
• EBP is NOT nursing research

• Integrates best current evidence with clinical expertise
• Respects patient/family preferences and values

Quality Improvement

• Fundamental elements
• Structure of care environment
• Care process
• Outcomes of care

• Use data to monitor the outcomes of care processes
• Use improvement methods to design and test changes to improve quality and safety of care

• Quality improvement
• Enhance safety knowledge through leadership, research, tools, and protocols
• Identify errors and learn from them
• Raise performance standards and expectations for safety
• Institute safety systems in healthcare organizations

Client has the right to:

• Disclosure of information
• Have choice of providers and plans
• Have access to appropriate high quality care
• Have access to emergency services
• Participate in treatment decsions
• Respect, nondiscrimination, and confidentiality
• Make complaints and appeals

Client also has responsibilities as the recipient of healthcare

• IOM's aims for healthcare
• safe
• effective
• patient-centered
• timely
• efficient
• equitable

• Required skills
• Share power and responsibility with patients and caregivers
• Communicate openly
• Respect patient individuality, needs, values, and life issues
• Create strategies to support the community as a whole
• Prevention and health promotion

• Advocacy
• Respect autonomy
• Empower patients to make decisions for themselves
• Defend patient rights
• Empowerment
• Patient and family encouraged to engage in self-care, decision making, and plan of care
• Respect and mutual decision making
• Self-management
• Collaboration between nurse and patient to select health goals, determine actions to meet the goals, and monitor progress toward the goals
• Health literacy
• Make sure patient is able to fully understand their illness and its treatment
• Cultural competence
• Respect differing cultures and values
• Understand and respect diversity
• Avoid disparity to provide quality healthcare

• Related skills
• Respect other team members' expertise, background, knowledge, and values
• Respect individual roles and processes
• Work collaboratively
• Demonstrate basic skills in communication, negotiation, delegation, time management, and group dynamics
• Provide accurate and timely information
• Customize care and management
• Ensure excellence, continuity, and reliability of care using coordination and integration
• Resolve conflicts within team
• Communicate in a shared language
• Ensure plan of care reflect's patient wishes by establishing primary commitment with the patient and family
• Use active listening and respect opinions of all team members

• Skills
• Know where and how to find the best sources of evidence
• Ask clear clinical questions
• Search for relevant answers where evidence is evaluated for validity
• Determine when and how to integrate findings into practice

• Steps to integrate evidence into practice
• Step 0
• Cultivate a spirit of inquiry in the work environment
• Step 1
• Identify a clinical question
• Use PICOT method: problem; intervention; comparison, outcome, time
• Step 2
• Collect best evidence
• Step 3
• Criticaly evaluate evidence for validity, reliability, and applicability
• Step 4
• Integrate evidence into other aspects of evidence-based practice
• Step 5
• Evaluate changes in relation to patient outcomes
• Step 6
• Share evidence-based decision or change

Nursing research uses systematic inquiry to find answers to problems and seek new knowledge. The goal is to develop reliable evidence (as opposed to finding it).

• Skills
• Compare current practice with relevant better practice
• Design and test interventions to improve quality care
• Identify errors and hazards in care and implement basic safety design principles
• Improve performance of self while continuing to act as an effective member of the interdisciplinary team