A National Strategy For Palliative Care.

In 2014 the World Health Organization called for palliative care to be integrated as an essential element of the health care continuum. Yet in 2017 US palliative care services are found largely in hospitals, and hospice care, which is delivered primarily in the home, is limited to people who are dying soon. The majority of Americans with a serious illness are not dying; are living at home, in assisted living facilities, or in nursing homes; and have limited access to palliative care. Most health care providers lack knowledge about and skills in pain and symptom management, communication, and care coordination, and both the public and health professionals are only vaguely aware of the benefits of palliative care and how and when to access it. The lack of policy supports for palliative care contributes to preventable suffering and low-value care. In this article we outline the need for a national palliative care strategy to ensure reliable access to high-quality palliative care for Americans with serious medical illnesses. We review approaches employed by other countries, list the participants needed to develop and implement an actionable strategy, and identify analogous US national health initiatives to inform a process for implementing the strategy.

Continuity of care: important, but only the first step.

Continuity of care is critical to achieving the best outcomes, especially for patients with chronic conditions. Israel's strong commitment to primary care as a central organizing concept of the health system, accompanied by investments in health information technology and training primary care physicians, has contributed to its impressive levels of continuity of care. Taking the next steps toward a comprehensive system of patient- and population-centered care for proactive management of patients with chronic conditions has much potential to further enhance outcomes and reduce costs.

The chasing zero department: making idealized design a reality.

OBJECTIVES: Leaders representing healthcare quality, purchasing, and certifying sectors convened at a national leadership meeting to address the issue of Healthcare-Associated Infections (HAIs). A session entitled "The Quality Choir: A Call to Action For Hospital Executives" featured harmonization partner organizations for the National Quality Forum Safe Practices (SPs) for Better Healthcare-2009 Update. (NQF SPs) The objective of the meeting was to determine if zero HAIs should be the improvement target for hospitals and what a Chasing Zero Department (CZD) should be like. METHODS: Discussion and consensus building among these experts determined what a CZD would look like and what it would take to implement it. RESULTS: Given that zero HAIs must be the goal, Hospital Infection Control Departments need to be restructured. CONCLUSION: Key design issues to the CZD addresses leadership, resources, and systems. Leadership: CEOs and boards must communicate to the organization that the typical Infection Control Group might be restructured into a CZD. The leader must provide "will, ideas and execution," recognize the power of collaboration, provide funding, and establish a roadmap through use of NQF SPs. RESOURCES: Funding for these efforts must be provided. Chief Financial Officers (CFOs) need to understand that zero HAIs will preserve revenue. Systems: Change can be made through leaders' championship, use of SPs, performing improvement, information flow and Automated Infection Identification and Mitigation System (AIIMS). These are the key to systems change toward zero HAIs.

Chasing zero: can reality meet the rhetoric?

OBJECTIVES: Leaders from healthcare quality, purchasing, and certifying sectors convened at a national leadership meeting held September 8-9, 2008 in Washington, DC to address issues of Hospital-Acquired Infections (HAIs). This paper provides opinion interviews from leaders who spoke at a session entitled "The Quality Choir: A Call to Action For Hospital Executives" on whether zero HAIs should be the goal of our Hospitals. METHODS: The successes of many hospitals in dramatically reducing their infection rates were examined toward goals of "Chasing Zero" infections. RESULTS: They agreed that the rhetoric of Chasing Zero HAIs must become reality, that anything less than aspiring to eradicate the risk of giving infections to patients for whom we deliver care is unacceptable. CONCLUSION: Every hospital leader must re-evaluate the strategy, structure, and function of their infection control and prevention services toward the following parameters: Zero HAIs must be the goal. Purchasers will no longer wait for hospital losses to act. Forces of harmonization are an unprecedented force. New-found hospitals' harmonized standards can move from "playing defense" to "playing offense" against HAIs. Leaders must ignite the passion of teams to make rhetoric a reality. Real stories about real people communicate through real caregiver values. The power trio of governance, administrative, and medical leaders must turn their potential energy into action. We have the "what" we need to aim for, the "how" to get the job done, and it is now about engaging the "who" to seize the opportunity. Embrace champions to lead the charge.

Measuring the contribution of nursing to quality, patient safety, and health care outcomes.

In 2004, the National Quality Forum (NQF) endorsed a set of voluntary consensus standards for nursing-sensitive care that quantifies nursing's contribution to patient safety, health care outcomes, and a professional work environment. Since endorsement, these consensus standards have been the basis for research, quality improvement, and policy setting. This article provides a summary of NQF's consensus development process and various efforts that have cascaded from the endorsement of these consensus standards.

Provider responsibility and system redesign: two sides of the same coin.

Patient safety is a serious problem that health care professionals and hospitals must confront. The health care delivery system must be redesigned. Health care professionals have a moral and ethical responsibility to actively participate in the development and operation of well-designed care processes. Efforts to redesign the delivery system will be most effective if accompanied by changes in the environment that shapes care delivery. Health care leadership must also focus attention on identifying the types of environmental changes needed at different levels, and on the part of specific stakeholders, to allow model twenty-first-century community health systems to develop.

Envisioning the National Health Care Quality Report March 2001

This publication represents the quality of health care received by the people of the United States falls far short of what it should be. There is a gap between the health care services that should be provided based on current professional knowledge and technology and those that many patients actually receive. It is clear that all resources are not used effectively or safety. Study after study documents are overuse of many services-the provisions of services when the potential for harm overweighs possible benefits. At the same time studies also documents underuse of other services-the failure to provide services from which the patient would likely have benefited.