Improving Mortality Through a Multihospital, Collaborative Quality Improvement Project.

Improving hospital mortality is a key focus of quality and safety efforts at both the local and national level. Structured interventions can assist organizations in determining whether interventional efforts have led to sustained improvement. The PARiHS framework (Promoting Action on Research Implementation in Health Services) can assist organizations in implementing research into practice. This study investigates the use of the PARiHS framework in implementing a multihospital quality improvement project aimed at improving observed-to-expected mortality as measured by Vizient's Clinical Data Base (CDB). Structured interventions during the study period included mortality reviews, clinical documentation improvement opportunities, educational webinars, training and support in the use of CDB to explore ongoing opportunities for mortality improvement and quarterly reports to each participating hospital's leadership team on their performance. Data were gathered from an improvement collaborative in the Upper Midwest, which comprised 34 hospitals, of which 17 participated in the intervention. Measurement occurred from Quarter 4 2016 through Quarter 3 2020 and consisted of a preintervention, intervention, and postintervention period. Although both participating and nonparticipating hospitals achieved a significant reduction in their mortality observed-to-expected ratio from the preintervention period through the postintervention period, the participating hospitals achieved a greater reduction in their observed-to-expected mortality ratio ( P < 0.0004). In addition, the participating hospitals achieved a relative 21% improvement in the mortality domain rank of the Vizient Quality & Accountability Study.

Paradoxes in Healthcare Leadership: Being-Nonbeing.

The paradox of being-nonbeing is explored from the perspective of the Vice President of Nursing and Clinical Services for a large rural integrated healthcare system in the United States. Being-nonbeing for the nurse leader is experienced daily. Being-nonbeing is experienced with self and others as she provides vision, leadership, and courageous support to the workplace and care environment.

A mother and daughter's reflections on nursing education. Interview by Sandra Schmidt Bunkers.

The following column presents a conversation with a mother and daughter enrolled in nursing education programs. Both mother and daughter utilized the teaching-learning strategies of dialogue and reflective journaling in coming to understand the meaning of their experiences in nursing education. The following ideas surfaced from their conversation: the importance of nursing theory-based teaching-learning, the importance of mentoring across the academic-clinical spectrum, the importance of questioning as a teaching-learning strategy, and, the importance of valuing time when developing teaching-learning experiences in nursing.