Quality manager an important team member

The hospital quality manager should play an important role in the implementation of an Integrated Nurse Leadership Program (INLP), says Julie Kliger, MPA, BSN, RN, INLP creator and program director at the Center for the Health Professions, University of California, San Francisco; principal and founder of The Altos Group; and lead author of an article in the Joint Commission Journal on Quality and Patient Safety detailing the successful implementation on INLP in seven Bay Area hospitals that led to significant improvements in medication administration.

"For all these initiatives you need a central governing body that should be made up of your quality people, the pharmacy, nurses, and so forth, so you can oversee and guide the work being done at the unit level," Kliger explains. "This needs to be seen as a collective piece of work, to help units that are struggling, and to share the knowledge of those that are doing well. In particular, the quality people can run more data and talk with staff to convince them of the importance of the initiative."

The quality manager also can play a role in convincing the administration that QI initiatives such as these are worth undertaking. According to Kliger, it is an easy pitch.

"Fundamentally, when I go to speak to hospital executives about this model, it's all about improving outcomes," she says. "And the hospitals have to do this anyway — improve outcomes, reduce malpractice and risk — so it aligns with their mission and organizational goals."

The "pitch" is now strengthened by a business case analysis conducted following the San Francisco study. "We had a very positive ROI [return on investment]; even if you fold in the costs (of retaining her services) and releasing the staff to do medication administration, it will come in at over 150%; so it's not only the right thing to do but it saves more money than you would by doing nothing," says Kliger.

According to the Institute of Medicine, Kliger adds, the cost of each medication administration error averages out to $10,600. "When you have a baseline error rate of 20%, and decrease that by 88% like we did, you save a lot of money — not to mention [avoiding] possible litigation," she says.