Quality and Safety in Nursing. Группа авторов
to our conversations. She and Dr. Hassmiller were leading efforts that crossed the quality and nursing portfolios at RWJF, and over the course of the next year, we continued in discussions about ideas for an initiative that would improve quality and safety education in nursing.
In 2004, Ms. Gibson and I spent hours during DSS debating the merits of various approaches to an initiative and its proposed products. One consideration was whether this work should be housed in a nursing professional organization, an idea promoted by the American Association of Colleges of Nursing (AACN). Nurses in the DSS community argued that we needed to reach all of nursing education, which by definition included diploma and associate degree schools as well as faculty in collegiate schools that are affiliated with the National League for Nursing. We proposed that the “thought leader” work would be stronger if done by experts in quality and safety, rather than appointees of professional organizational task forces who at times are assigned for reasons other than topical expertise. We wanted to involve and share the work with leaders from all the organizations that supported nursing licensure, certification, or accreditation of nursing education programs, and thought that would more likely occur if the initial grant were housed in a neutral site. In the end, these views prevailed, and we received an official invitation to submit a proposal.
As the RWJF decision‐making processes advanced, Ms. Gibson provided guidance about the need to break the initiative into short phases that, if successful, could build on each other. We were charting unknown territory and did not yet have a basis for knowing how open or resistant nursing faculties would be to this paradigm shift. She suggested taking the work one piece at a time so that we could adapt the methods to the needs that emerged. Her experience with other major RWJF initiatives (e.g., palliative care) was invaluable, and the final proposal was a true partnership with a visionary philanthropic leader.
Members of the DSS community responded to proposal drafts and, most importantly, agreed to play key roles as members of the QSEN faculty (Barnsteiner, Disch, Moore, and Mitchell) and advisory board (Batalden and Hall). Ironside’s participation in the DSS community began soon thereafter. At the same time, Dr. Gwen Sherwood became the Associate Dean for Academic Affairs at UNC‐Chapel Hill. As someone experienced with patient safety initiatives, she was not only a knowledgeable local colleague but also someone with whom I could share the responsibilities of project management. We invited the participation of people we thought would be the strongest contributors with respect to each competency, area of pedagogical expertise, and the major nursing organizations associated with licensure and accreditation. Amazingly, every person invited to participate said yes.
Building Will: Phase I (October 2005–March 2007)
Funding for Phase I began October 1, 2005, and we held the first faculty/advisory board meeting 30 days later. For 18 months, this group (see Table 3.1) worked intensively to propose competency definitions and learning objectives for the quality and safety domains outlined in the IOM (2003) report on health professions education, assess faculty views about the current state of quality and safety education, and develop a website through which we could share teaching strategies, annotated bibliographies, and other quality and safety education resources.
Phase I Impact Factors
What Phase I factors contributed to QSEN’s eventual influence? First, the underlying issue was a major public concern based on documented quality and safety problems (Kohn, Corrigan, and Donaldson, 2000). The need for changes in health professions education had been made, strongly and clearly, by respected leaders (IOM, 2003), but the knowledge of the implications of this work by health professional faculties was minimal at best. We needed QSEN thought leaders who had the requisite expertise in the competencies (patient‐centered care, teamwork and collaboration, evidence‐based practice, quality improvement, safety, and informatics) and teaching pedagogies (clinical, classroom, skills/simulation laboratory, and interprofessional education). But we also needed leaders who had bridged the academic and practice worlds through personal commitments and experiences working to improve the health of populations, health care system performance, and professional development. We needed people who could tell stories about the knowledge, skills, and attitudes required to fundamentally improve health and health care.
QSEN faculty and advisory board members brought these attributes to the work and deepened their learning in dialogue with each other as the work progressed. For starters, QSEN’s spread was derived from the importance of the problem and the unique expertise of QSEN leaders, whose collective experiences with improving both patient care and health professions education provided a strong platform for new ways of thinking about quality and safety education in nursing.
Second, eight faculty and advisory board members were members of the DSS community, and thus they were familiar with how to use group processes to generate new ideas. These QSEN leaders had witnessed change in the world of health care improvement and health professions education as a result of DSS community work, and were experienced at “thinking big” in attempts to improve health, health care, and health professions education. We were also imbued with the philosophy of community work expressed annually by Dr. Batalden, namely:
Practice hospitality that invites open sharing. Help keep the space open for exploration.
Practice your own trustworthiness and enhance the trustworthiness of the commons.
Share generously, but no stealing. Protect each other’s futures.
Practice listening and dialogue, more than telling and discussion.
Reflect into the gift of silence when it occurs, rather than rushing to obliterate it with words.
Table 3.1 QSEN Faculty, Staff, and Advisory Board Members
| Project Team | Faculty—Competency Experts | Faculty—Pedagogy Experts | Advisory Board Members |
|---|---|---|---|
| Project Investigators | Jane Barnsteiner1 University of Pennsylvania | Carol Durham UNC‐Chapel Hill | Paul Batalden1 , 2 IHI, ACGME |
| Linda Cronenwett1 , 2 UNC‐Chapel Hill | |||
| Lisa Day UC‐San Francisco | Geraldine (Polly) Bednash AACN Executive Director | ||
| Gwen Sherwood UNC‐Chapel Hill | Joanne Disch1 University of Minnesota | ||
| Pamela Ironside1 , 2 Indiana University | |||
| Librarian | |||
| Jean Blackwell | Jean Johnson George Washington University | ||
| Shirley Moore1 Case Western Reserve University | Karen Drenkard AONE | ||
| Project Managers | |||
|
Elaine Smith
|