Improving the safety and quality of nursing care through standardized operating procedures in Bosnia and Herzegovina.

AIM: We explored how selected 'positive deviant' healthcare facilities in Bosnia and Herzegovina approach the continuous development, adaptation, implementation, monitoring and evaluation of nursing-related standard operating procedures. BACKGROUND: Standardized nursing care is internationally recognized as a critical element of safe, high-quality health care; yet very little research has examined one of its key instruments: nursing-related standard operating procedures. INTRODUCTION: Despite variability in Bosnia and Herzegovina's healthcare and nursing care quality, we assumed that some healthcare facilities would have developed effective strategies to elevate nursing quality and safety through the use of standard operating procedures. METHODS: Guided by the 'positive deviance' approach, we used a multiple-case study design to examine a criterion sample of four facilities (two primary healthcare centres and two hospitals), collecting data via focus groups and individual interviews. FINDINGS: In each studied facility, certification/accreditation processes were crucial to the initiation of continuous development, adaptation, implementation, monitoring and evaluation of nursing-related SOPs. In one hospital and one primary healthcare centre, nurses working in advanced roles (i.e. quality coordinators) were responsible for developing and implementing nursing-related standard operating procedures. Across the four studied institutions, we identified a consistent approach to standard operating procedures-related processes. CONCLUSIONS: The certification/accreditation process is enabling necessary changes in institutions' organizational cultures, empowering nurses to take on advanced roles in improving the safety and quality of nursing care. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Standardizing nursing procedures is key to improve the safety and quality of nursing care. Nursing and Health Policy are needed in Bosnia and Herzegovina to establish a functioning institutional framework, including regulatory bodies, educational systems for developing nurses' capacities or the inclusion of nursing-related standard operating procedures in certification/accreditation standards.

Developing a financial framework for academic service partnerships: models of the United States and Europe.

PURPOSE: Academic service partnerships (ASPs) are structured linkages between academe and service which have demonstrated higher levels of innovation. In the absence of descriptions in the literature on financial frameworks to support ASPs, the purpose of this paper is to present the supporting financial frameworks of a Swiss and a U.S. ASP. METHODS: This paper used a case study approach. RESULTS: Two frameworks are presented. The U.S. model presented consists of a variety of ASPs, all linked to the School of Nursing of the University of Pennsylvania. The structural integration and governance system is elucidated. Each ASP has its own source of revenue or grant support with the goal to be fiscally in the black. Joint appointments are used as an instrument to realize these ASPs. The Swiss ASP entails a detailed description of the financial framework of one ASP between the Institute of Nursing Science at the University of Basel and the Inselspital Bern University Hospital. Balance in the partnership, in terms of both benefit and cost between both partners, was a main principle that guided the development of the financial framework and the translation of the ASP in budgetary terms. The model builds on a number of assumptions and provides the partnership management within a simple framework for monitoring and evaluation of the progress of the partnership. CONCLUSIONS: In operationalizing an ASP, careful budgetary planning should be an integral part of the preparation and evaluation of the collaboration. The proposed Swiss and U.S. financial frameworks allow doing so. CLINICAL RELEVANCE: Outcomes of care can be improved with strong nursing service and academic partnerships. Sustaining such partnerships requires attention to financial and contractual arrangements.