Response 7 Vsm Quality of care in the healthcare system surfaced in the 19th century with Dr. Semmelweis who institutionalized handwashing in his practice

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Quality of care in the healthcare system surfaced in the 19th century with Dr. Semmelweis who institutionalized handwashing in his practice. Changes in healthcare are realized because of the constant demands and pressure placed upon the system and legislation (health policies), by the people and simple changes performed by innovative individuals. The Institute of Medicine (IOM) in the United States, defines quality of care as a degree of care which is calculated based on safety, effectiveness, efficiency, fairness and centered solely on the patient. APNs (Advance Practice Nurses), the newest sub-specialty, creating the buzz in healthcare around the nation must at any cost function in an environment of fairness, low cost, quality, fluid communication, and patient centered. APNs provide a wide range of health care services including the diagnosis and management of acute, chronic, and complex health problems, health promotion, disease prevention, health education, and counseling to individuals, families, groups, and communities. In today’s ever-changing healthcare landscape, the role of APNs has never been more important than in acute and primary care. Therefore, it is primordial to maintain a certain level of quality to have the system beneficial for the patients, and profitable to all stakeholders. 

How to measure and monitor the quality of care delivered by an Advanced Practice Nurse   

How do we know if the system is compassionate, patient-centered, and the staff are skilled? How do we measure quality? The National Quality Forum (NQF) has provided the healthcare industry for the past 30 years with the tools to measure and monitor the level of quality provided. The first element was to recognize the standards and compare the performance realized with the said standards. NQF has been adopted by both private and governmental entities for payment and assisting organizations in attaining the highest level of quality.   

The measurement of quality by an APN is the notification of the percentage of positive health outcomes. With the documentation of the outcome’s assessments, it is reliable to produce a file with the cumulative procedures and outcomes. APNs also should reassess their private practice to continuously better data recording, monitoring processes, communication, etc. Continuing overall improvement in the system lead to the highest quality of care (Schober & Stewart, 2019). The APNs must assess the quality of the service compared with the appropriate standards. In case the level is not up to par, continuing education and consultation with other APNs or physicians are options.  

 How to measure and monitor the outcomes achieved by an Advanced Practice Nurse?  

 The measurement of outcome for the past few years has incorporated the involvement of the patient for the service to be more patient-centered inclined. Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are measures that relay to the entity the information straight from the ultimate stakeholder, the patient.  

The delivery of the outcome’s information differs from the recipients because the requesters could be patient, organizations, government, family members (Hamric, 2013). The outcome assessment is an evaluation of the fallouts of the healthcare staff’s actions. The assessment provides the necessary to review the course of actions and to proceed with different treatment. Outcome indicators, metrics, or measures must be clearly described and understood by the practitioners to gather realistic and reliable data. Intermediate outcome indicators are used as an alarm system that captures the practitioner’s attention that the route being taken is either in the right direction or away from the desirable outcome. Intermediate outcome indicators capture all the changes being processed by staff to correctly guide the system towards the final desired outcome.  


The increasing demand for a patient-centered care, friendly, not costly and the ever-increasing shortage of primary care physicians created substantial gap in the system and open the door for an exponential number of independent clinical practice (Hahn & Cook, 2018). The opportunity for the APNs to shine and reach their full potential is now. Therefore, the quality of the APNs’ service must be beyond reproach and the measurement and monitoring of service quality and outcomes must be in place to maintain this well-deserved, and long awaited acquired status.   

The healthcare industry has been using the National Quality Forum (NQF)’s tools to measure and monitor the level of quality provided. Measuring quality of processes and other relevant data such as health outcomes, patient safety, care coordination, patient engagement, is simply a comparison with the recorded data with the standards. APNs are encouraged to use the NQF measures since they have proven their efficacity and efficiency throughout the years. 



Schober, M., & Stewart, D. (2019). Developing a consistent approach to advanced practice nursing worldwide. International nursing review, 66 (2), 151-153.  

Hahn, J. A., & Cook, W. (2018). Lessons Learned from Nurse Practitioner Independent Practice: A Conversation with a Nurse Practitioner Entrepreneur. Nursing Economics, 36(1), 18-22.  

Hamric, B. A., Hanson, M. C., & Tracy, F. M., & O’Grady, T. E. (2013). Advanced Practice Nursing: An Integrative Approach (5th ed.). Saunders.   ISBN:   9781455739806 

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