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Quality foundations and effective leadership: The recipe for better clinical outcomes

Published Date
Author Shanda Hellen MSN-RN

Coauthored by Katherine Leech, Product Management Director, Press Ganey.

Great environments produce great outcomes. This age-old mantra is relevant even in healthcare—and the latest findings from the National Database of Nursing Quality Indicators (NDNQI) registered nurse (RN) surveys affirm this simple truth. 

While it’s largely understood that the practice environment significantly impacts personal performance and workforce outcomes, what’s less clear is, how does this environment relate to patient outcomes?

Creating a thriving practice environment for nurses

But first, what makes for a great practice environment for the nursing workforce? One major influence is leadership, the nurse managers we work with directly, and our colleagues on the front lines.

This topic is near and dear to me. Back in 2012, I was a young and impressionable new nurse, just trying to find my way in the industry. But I was dedicated to my patients, and committed to performing well in my role. I still remember one manager who inspired my journey and ignited my passion as a nurse. She encouraged me to get involved in areas outside of patient care, which was key to my professional development.

My first project was redesigning the NICU environment to protect the developing eyes of premature infants. That was only the beginning. Many projects later, I was involved in a large-scale hospital transition, moving a maternal center inside the walls of a children's hospital. This required extensive clinical expertise to create a new environment tailored to the needs of a new patient population. 

With the support of clinical nurses, the practice environment only gets better. And without great nurse leader relationships, many nurses’ involvement in these projects would have never existed.

In short, when nurses are empowered by their managers, the practice environment thrives.

A positive practice environment is key to improved patient experience and clinical outcomes

A recent Press Ganey study puts data behind something that we might know intuitively: Nurse-sensitive adverse event rates are lower in healthier practice environments. That is, when nurses work in a healthier practice environment, safety events decrease, the patient experience improves, and the organization operates in a more highly reliable way.

Healthy practice environments correlate to decreased rates of CAUTI, CLABSI, falls, and HAPIs.

We measured healthier environments by looking at leadership, nurse-to-nurse interactions, quality of care, and more factors. Units with better work environments had lower nursing-sensitive adverse event rates. 

Significant differences in mean averages in NSIs based on RN survey PES sub-scale unite scores

These findings should motivate all nurse leaders to foster environments with emphasis on quality leadership and a solid foundation of quality of care. With RN survey season in full swing for many nursing units across the country, below are a few ideas to get started improving your practice environment.

  • Collaborate with nurses to define what high-quality care and service looks like.
  • Set actionable goals for nurses that promote a culture of high-quality care.
  • Discuss how nurse resilience affects patient safety.  
  • Establish a goal of zero harm, and outline expectations for achieving that goal. 
  • Share positive patient experience data, comments, and/or stories to underscore the importance of providing high-quality care.
  • Talk to nurses about how they envision safe patient care, and establish a shared vision. 
  • Create a forum for nurses to share their insights into the challenges around providing error-free care, then involve them in problem-solving to remove those barriers. 
  • Provide nonpunitive, constructive feedback when nurses report a safety event.

Improving the health of our communities, and the ones we love, is what brought so many of us to this industry.  But for nurses to provide the highest-quality care to patients, they need to be cared for, too. That often starts with their work environment. Reach out to a member of our nursing team to learn more.