The mission of the Agency for Healthcare Research and Quality (AHRQ) is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. The agency promotes health care quality by conducting and supporting health services research, reviewing and disseminating evidence on health care, and promoting improvements in clinical and health system practices. Therefore, it is fitting that we sponsored the conference on The Intersection of Nursing and Health Services Research, conducted by the University of North Carolina at Chapel Hill School of Nursing in May 1994.
AHRQ has enjoyed a long-standing and productive collaboration with nurse researchers.
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The agency has hosted several expert and stakeholder meetings since 1992 on nursing, health services research, and capacity-building needs. In the area of research grants, AHRQ has sponsored or co-sponsored over 150 grants to nurse principal investigators.3
The set of grants on health care working conditions illustrates the closeness of nursing to health services research with 15 of 21 projects having nursing variables or investigators.4
While the intersection between nursing and health services research is not new, it was explored more fully during this conference than in the past. We congratulate the conference organizers and participants for generating the series of articles herein and Nursing Outlook for publishing a supplemental issue so that we can all benefit from this important conference.The article’s authors discuss issues of access to care/nursing workforce, health behavior, quality of care, cost/cost-effectiveness, and organization/delivery of care, and they also present an agenda for nursing health services research. These areas represent the areas of foci of the conference as well as reflecting AHRQ’s strategic goals of improving quality care and patient safety, effectiveness, and efficiency of healthcare. Health care is AHRQ’s passion and quality its trademark.
The AHRQ agenda for quality and patient safety is to reduce the risk of harm from healthcare services by using evidence-based research to promote the delivery of the best possible care. Nurses are an indispensable part of the multidisciplinary teams that are finding solutions to improve patient safety and, ultimately, to benefit patients by improving their outcomes. In transforming the healthcare system, each player in the system has a role and each role is significant.
The Institute of Medicine’s 1999 landmark report, To Err Is Human: Building A Safer Health System,
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created momentum for the patient safety movement of today. Five years later, a survey6
by the Kaiser Foundation, the Agency for Healthcare Research and Quality, and the Harvard School of Public Health illustrated that the issue is still critical and should be kept in the forefront of research and policy efforts. For example, 1 in 3 respondents reported that they or a family member experienced a medical error at some point in their life, including one-fifth who said it had caused serious health consequences such as death, long-term disability, or pain. Moreover, Americans say that they do not believe that the nation’s quality of care has improved. The survey found that 40% of people say the quality of health care has gotten worse in the past 5 years, while 17% say the quality of care has gotten better, and nearly 38% say it has stayed the same.6
The key to improving quality and reducing medical errors is to change the culture of health care. As Dennis O’Leary (President, Joint Commission on Accreditation of Healthcare Organizations) noted in his 2003 testimony before the Senate Committee on Governmental Affairs, “adopting such a culture is the overarching strategy that is necessary to the realization of the full impact of other solutions to the problem, and thus the single most important strategic effort to be undertaken.”
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To that end, AHRQ-sponsored researchers developed a hospital survey on patient safety culture which was released last year in partnership with Premier, Inc, the Department of Defense, and the American Hospital Association.
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The survey can be used to evaluate employees’ attitudes about patient safety in their facilities or within specific hospital units. It measures organizational conditions that can lead to adverse events and patient harm. The survey includes assessments of a variety of organizational factors that have an impact on patient safety, including developing awareness about safety issues, evaluating specific patient safety interventions, tracking changes in patient safety over time, setting internal and external benchmarks, and fulfilling regulatory requirements or other directives.The goal for effectiveness is to improve healthcare outcomes by encouraging providers, consumers, and patients to use evidence-based information to make informed treatment choices/decisions. Recently, AHRQ released the second annual editions of The National Healthcare Quality Report
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and its companion, the National Healthcare Disparities Report,10
which provide data on the quality of health care and disparities in the use of healthcare services. These reports are rapidly becoming an important part of the nation’s tracking system for healthcare quality and disparities. They also have been a catalyst to the science of developing quality measures that improve data collection and quality improvement efforts. A critical frontier for health services research is in moving from measurement to improvement. The science of measurement has advanced considerably, and ample evidence indicates that health care professionals and the public in general are increasingly interested in improving the quality and effectiveness of health care.For the past decade, there has been growing recognition that the patient’s perspective on and preferences for care are critical dimensions of quality. Patients and consumers struggle with basic decisions: which provider to see, when to seek care, and which treatment option is best for their needs. Many of these decisions are difficult even in the most ideal circumstances, such as when there is sufficient time to assess good, reliable information. Unfortunately, these decisions frequently have to be made at times and places where information is not available and time is of the essence. In addition, it is not always clear which information is reliable or if reliable information is accessible in real time.
This lack of clarity leads to consideration of efficiency. It is of utmost importance to transform research into practice in order to achieve wider access to effective healthcare services and reduce unnecessary healthcare costs. This transformation can occur more readily when partnerships with other health organizations occur. Therefore, AHRQ works with leading public- and private-sector organizations to help translate its research into improved health care practice and policy. This work of translation is a critical step for improving quality care. As evidenced by the articles in this supplement, a health services research approach can implement this translation of research into practice and policy.
An essential part of translation is ensuring that research findings are ready to use when needed by all partners and health care decision-makers: policymakers, private-sector leaders, providers, clinicians, and patients/consumers. For nurse partners, the agency has made several contributions, such as commissioning Keeping Patients Safe: Transforming the Work Environment of Nurses.
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This report provides guidance on how to design a work environment in which nurses can provide safer patient care. A systematic review, The Effect of Health Care Working Conditions on Patient Safety12
concludes that strong evidence exists that workforce staffing and workflow design affect medical errors and patient safety outcomes. AHRQ funded a special program of research on working conditions, with the majority of projects focusing on nursing. Results from these studies will be released in the coming year. In the meantime, the existing body of AHRQ research on the nursing workforce as been summarized in Research in Action: Hospital Nurse Staffing and Quality of Care.13
The current research supports other reports that demonstrate that nurse staffing and quality care are integral concepts.The term “intersection” brings to mind a traffic intersection where 2 roads cross, but several methods of traffic flow can be implemented. In the traditional form, researchers pass through the intersection, vaguely aware of traffic around them, on their way to some other place (outcome). A more successful intersection would be one where researchers can map their focus so they travel in collaboration with other research traffic. The agenda created in this conference and presented herein can provide a roadmap for success.
The views expressed in this article are those of the authors and do not necessarily reflect those of the Agency for Healthcare Research and Quality or the US Department of Health and Human Services.
All authors were employees of the US Federal Government when this work was conducted and prepared for publication. Therefore, it is not subject to the Copyright Act, and copyright cannot be transferred.
References
- Evidence-based resources for nurses.Nurs Outlook. 2004; 52: 215-217
- Translating Research into Nursing Practice.Nursing Outlook. 2005; 53: 46
- Funded Grants Submitted by Nurses. 1980-2005 (Available at: http://www.ahrq.gov/about/nursing/nursfund1.htm. Accessed April 2005.)
- Impact of working conditions on patient safety. Fact sheet. 2002 (AHRQ Publication No. 03-P003, October. http://www.ahrq.gov/news/workfact.htm. Accessed May 2005.)
- Kohn L. Corrigan J. Donaldson M. Institute of Medicine. To err is human building a safer health system. National Academy Press, 2000
- Five Years after IOM Report on medical errors, nearly half of all consumers worry about the safety of their health care P.R. 2004 (Nov. 17, Available at http://www.kff.org/kaiserpolls/pomr111704nr.cfm. Accessed April 2005.)
- Patient safety. Testimony before Senate Committee on Governmental Affairs, 2003 (June 11)
- New AHRQ survey helps hospitals measure and improve patient safety culture. Press Release, 2004 (Nov. 10, Available at: http://www.AHRQ.gov/news/press/pr2004/hospcult2pr.htm. Accessed Apr. 2005.)
- 2004 National Healthcare Quality Report. Department of Health and Human Services, Agency for Healthcare Research and Quality, Rockville, MD2004 (AHRQ Pub. No. 05-0013)
- 2004 National Healthcare Disparities Report. Department of Health and Human Services, Agency for Healthcare Research and Quality, Rockville, MD2004 (AHRQ Pub. No. 05-0014)
- Page A. Keeping patients safe transforming the work environment of nurses. The National Academies Press, 2004
- The effect of health care working conditions on patient safety. Evidence Report/Technology Assessment Number 74. Agency for Healthcare Research and Quality, Rockville, MD2003 (AHRQ Pub. No. 03-E031. (Prepared by Oregon Health & Science University under Contract No. 290-97-0018.))
- Hospital nurse staffing and quality of care. Agency for Healthcare Research and Quality, Rockville, MD2004 (Research in Action Issue 14. AHRQ Pub. No. 04-0029)
Article info
Footnotes
Carolyn Clancy is a Director at the Center for Outcomes and Evidence, Agency for Healthcare Research and Quality, Rockville, MD.
Beth A. Collins Sharp is a Health Scientist Administrator at the Center for Outcomes and Evidence, Agency for Healthcare Research and Quality, Rockville, MD.
Heddy Bishop Hubbard is a Senior Advisor for Nursing at the Center for Outcomes and Evidence, Agency for Healthcare and Research and Quality, Rockville, MD.
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Copyright
© 2005 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
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