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March / April 2005
Quality Metric
Proceedings from the Quality Colloquium
Implementing Evidence-Based Guidelines and Reporting Results Through a Quality Metric
Yosef D. Dlugacz, PhD;
Andrea Restifo, RN, MPA, CPHQ;
Karen Nelson, RN
Although it is generally acknowledged that evidence-based medicine (EBM) reflects expert consensus about the standard of care in specific disease processes, implementing guidelines that incorporate EBM meets with a great deal of resistance. Therefore, the challenge facing healthcare organizations is not in establishing the value of EBM, which has been widely recognized for years and by many experts, but in how to change habituated practice, physician reluctance, and an unsupportive hospital culture so that guidelines are more readily embraced. Data are compelling and persuasive to administrators and physicians, especially comparative data that target specific patient populations and that illustrate improved patient safety and successful outcomes.
Leadership's acceptance of the value of EBM as a tool to improve operational performance and clinical outcome is crucial for success. The national safety movement specifically identified an organization's leadership as critical to promoting changed practices. For EBM to become operationalized, the CEO has to promote support by establishing explicit policies and procedures. The Medical Board must also endorse and approve EBM as the community standard of care. Accreditation agencies set standards of care and recommend guideline use to ensure uniformity of practice across the continuum. However, because the medical staff is voluntary and thus not integrated into the hospital organization, encouraging compliance with guideline use requires appealing to their good will. To implement EBM at the bedside for the healthcare team, education and communication are central.
To develop techniques that will bridge the disconnect between actual practice and what are known to be best practices and highest-quality standards, the North Shore-LIJ Health System (NS-LIJHS)ãcomprised of 15 hospitals, including community, tertiary hospitals, and spanning diverse services, such as long-term care facilities, rehabilitation, and behavioral health facilitiesãhas promoted the development and use of guidelines. The CEO encourages education of our 32,000 employees through the Center for Learning and Innovation and through the new employee orientation program, known as Foundations. Quality is a key element of the teaching. As of today, 480 managers, 5,757 orientees, and approximately 2,000 nurses have received this education. A quality management rotation for nurses and fellows has been implemented as well (Figure 1).
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