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. Author manuscript; available in PMC: 2013 Oct 1.
Published in final edited form as: Nurs Forum. 2012 Oct;47(4):260–267. doi: 10.1111/j.1744-6198.2012.00283.x

Table 1.

Causes of Quality Problems and Approaches to Quality Improvement

Causes of
Quality
Problems		 Supporting Evidence Approaches to Quality
Improvement
1. Inefficient healthcare system

  • Introduce concept of QI from manufacturing industry

  • Streamlining process to produce better outcomes

  • Replacing professional judgment with rules and protocols
2. Lack of systematic evaluation

  • “Crossing the quality chasm” Institute of Medicine (2001)

  • JCAHO added quality measures in their accreditation criteria (2002)

  • CMS invited and later requested hospitals to submit and publish data regarding hospital quality measures (HQI; 2008)

  • ANA collects national data related to nursing care quality (NDNQI)

  • Provide financial incentives to do better on quality measures

  • Disclose quality information to public for competition

  • Provide national benchmarks to evaluate quality of care
3. Insufficient staffing

  • Insufficient nurse staffing causes poor quality of care (ANA, 1999)

  • Higher patient-nurse ratio was associated with negative patient outcomes (Aiken et al, 2002)

  • Low RN staffing was associated with increased mortality (Needleman et al., 2011)

  • Decreasing patient-to-nurse ratio (E.g., mandated minimum staffing ration in California)

  • Educating public about nursing contribution to quality care

  • Expanding admissions to nursing schools to increase workforce