Grantee Profiles
Pat Noga and Barry Kitch
What Lessons Can Be Learned From Publicly Reporting Nurse Quality Measures? An interview with Pat Noga and Barry Kitch.
When the National Quality Forum endorsed a set of standards to help evaluate how hospital nurses contribute to patient safety and quality, it marked a major step forward in efforts to show the link between nursing and better care. Whether publicly reporting the nurse-sensitive measures matters when it comes to quality is a question INQRI researchers Patricia Noga and Barry Kitch are exploring. By examining and comparing the experiences of Massachusetts and Maine, where all acute care hospitals are now participating in public reporting programs – they hope to share lessons that will help guide other states considering doing the same.
"What is exciting about this effort is that these states are the first to commit to publicly report nursing sensitive quality measures to assess and assure quality," says Kitch, a physician and health policy researcher at Massachusetts General Hospital's Institute for Health Policy. "They offer an important glimpse into what a program for public reporting about nurse-sensitive quality measures looks like and what lessons can be learned from stakeholders and hospital leaders about programs designed to promote transparency."
Kitch, Noga, an RN and senior director of clinical affairs at the Massachusetts Hospital Association, and their team have recently finished conducting interviews with stakeholders in both states. They've sought input from hospital leaders, organizations of nurse executives, state nurses associations, leaders of quality assessment and standards organizations, the Maine Quality Forum, and others. They also have surveyed policymakers in the two states. They will have results to share sometime in early summer 2008.
They plan to answer a number of important questions and gain a better understanding of what it takes to do public reporting of such data, why the states decided to make this information public in the first place, and whether the hospital leaders in both states believe that the public reporting programs have led to improvements in the quality of nursing care and patient outcomes. They also want to be able to measure the effect of public reporting on patient care and safety and assess the burden these programs impose on adopters. "We are looking to see whether there has been a significant change in what hospitals had been doing. Are they spending more time discussing nurse sensitive quality measures as a result of this or are they enacting new initiatives around the specific measures?," says Noga. Noga and Kitch also want to better understand hospital CEO and CNO perceptions about the utility of public reporting and whether they think such data is likely to be used by consumers.
One common thread they have seen is related to what prompted the development of the reporting programs. A key motivation for both states was tied to concern about coming up with the appropriate level of nurse staffing in hospitals and the merits of state-mandated nurse ratios. Many states are facing the same question but there is not enough information or research to support policies mandating a set number of patients per nurse. Being able to measure and report on such things as the prevalence of falls, pressure ulcers, use of restraints, or central line catheter infections, can help hospitals, payors, regulators, and the public both assess and improve the quality of nursing care in their hospitals, says Kitch.