Quality Improvement Specialist (Nurse)

There is increasing emphasis on improving the quality of care provided by hospitals. Nurses are integral to patients' well being both in and out of acute care facilities; nurses are pivotal in hospital efforts to improve quality. Hospitals face increasing demands 
to participate in a wide range of quality improvement activities, they are reliant on nurses to help address these demands.

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Quality Improvement Specialist (Nurse)

Majority of quality improvement jobs in health care can have many responsibilities that fall into specific categories, including but not limited to evaluation, analysis, training and education, regulatory and compliance responsibilities, and risk management. A quality improvement health care specialist would ideally be responsible for gathering and evaluating clinical data from the organization; analyzing data for patterns and trends in the delivery of healthcare; researching root causes for specific patient care trends; training and educating staff to promote good quality practices and ensure compliance with all applicable laws and regulations; working with leadership and staff to create policies and procedures to ensure good quality care and minimize harm to the patient; keeping up to date with all federal and state laws and regulations.

Quality improvement can be defined "as systematic, data-guided activities designed to bring about improvement in health care delivery in certain settings and particular situations".

A quality improvement strategy is defined as "any intervention aimed at reducing the quality gap for a group of patients represented by those encountered in routine practice".

Gaining a more in-depth understanding of the role that nurses play in quality improvement and the challenges nurses face can provide important insights about how hospitals can optimize resources to improve patient care quality.

Educational Requirements

  • Registered Nursing License in State of
  • 3-5 years clinical nursing experience
  • BSN preferred
  • Experience with NCQA, Medicaid and/or commercial regulatory requirements
  • CPHQ- Certified Professional in Healthcare Quality (preferred)

Duties and Responsibilities

Participate in design and implementation of Quality Improvement projects for HMO patients.

Assumes project lead role and develops project plan identifying all aspects of the project including timeline's for each task. Assures timely collection, processing and reporting of data per project.

Collaborates with IT and Analytic staff to facilitate design and development of appropriate database tools and reports.

Serves as a proactive liaison to Medical Leadership to facilitate physician engagement in projects, timely completion and submission of QM projects and HEDIS data collection and development of interventions for improvement.

Investigate patient complaints/grievances received from patients, family and HMO's.

Conduct QI audits/surveys as a way to recognize and/or identify potential quality issues or trends.

Attend various interdepartmental meetings as the QI RN representative, to support the departments' requirements.

Opportunities

Improving health care quality and patient safety are currently high on the nations health agenda, a focus that will only intensify going forward. Patients are demanding better health care, and who can be placed better than the nurse to be the leader of quality.

In other countries, it is the expectation that all registered nurses are actively involved with improving quality initiatives through research, changes are made through the hard work of floor nurses who strive daily to improve quality outcomes.

We need to be given the recognition of being change agents, quality improvers and educators. Self identification of issues and problems should be the norm rather than the exception. We should be identifying areas of improvement, making plans of correction and auditing the plans are effective after they are implemented.

The stakes for US hospitals to demonstrate high quality is increasing; at the same time resources are becoming more and more limited. Therefore, hospitals will have to become more skillful and sophisticated in discerning and pursuing activities that substantively contribute to the achievement of their quality.

This evolution also will require increased sophistication by the hospitals to optimize available resources to carry out their work.

Nurses are at the forefront of improving quality care, although it is considered everyone's responsibility to improve quality of care. Nurses often find themselves in the unique position of being the change agent for any patient quality event, we have a high stake in the game and we need to cash in on all opportunities that could improve the quality of life for our patients.

Resources

National Association for Healthcare Quality (NAHQ)

National Committee for Quality Assurance (NCQA)

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madwife2002

About madwife2002, BSN, RN

RN with 26 years of experience many of those years spent in dialysis. I have worked in acute care, home, ICHD as a CN, FA, and currently a director.

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I'm going for my 2nd interview as a Quality Improvement Nurse for Humana. If anyone currently holds that position and has held in the past, I would love to hear your input and opinion.

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I work as a Quality Improvement Nurse for Humana. I've been with them for about a year and so far it's good. I work from home but travel about 50% of the time. I contact providers and talk with them about our clinical programs, HEDIS measures, keeping the member (patient) out of the hospital, etc. It's just like any other job - it's what YOU make of it. Good LucK

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I assume your 50% of travel is to physicians offices? Is it pretty much a Monday - Friday job? Working 8 to 10 hours? Do you have a minimum number of providers your have to visit in one week, one day? Is it tough getting into their office to discuss this with them?

Thank you so much for your input.

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Yes, I travel to physicians offices, expected to make 12 visits a week. I work mostly 8 hour days but there are times when it's a 10 - 12 hour day depending on travel. As far as meeting with the providers, I control my own scheduling which is great. When I first started it was kind of hard for me to get into the provider offices but now it's not a problem at all - I just had to develop my own style. It's not for everyone, you have to be versatile, work independently with little direction (I'm guessing you're working from home) but that's been a plus for me. (also it's a Mon - Fri job)

Have you had your 2nd interview yet, how did it go?

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I have it on Wednesday. I'm just struggling with this and my current job that I have. I am an agency nurse working PRN with so much flexibility and ability to take time off whenever I want. I am a bit torn.

Thank you so much for your input. It's really helpful.

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That's so funny, I was in the same situation you were in. When I was offered the job I was working PRN with a lot flexibility, believe me, I struggled with the decision too. I decided to take it because I wanted the benefits (PTO, etc), I'm glad I took the job, they're a good company to work for.

I hope all goes well, would love to hear an update in the next few weeks!

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Specializes in Cardiovascular.

Thank you for the information. I am looking into crossing over into Quality after being in patient care for 20 years. Any advice of making this a smooth transition would be greatly appreciated.

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Specializes in Quality Improvement / Informatics.

Hey nurses, I've been a nurse for 19 years and have been in the quality improvement department for nearly a decade.

My questions to you all are, in your hospital:

Do you have any contact with people in the Quality department?

Do you know what the quality improvement nurses actually do?

If so, what irks you about them?

And if so, what, if anything, do you learn from them?

As a quality staff nurse, I know that managers know us, but unfortunately feel transparent to floor and clinic nurses. I've always been curious about how we're perceived out there

Be honest I want to know!

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Specializes in Palliative, Onc, Med-Surg, Home Hospice.

At the facility I worked at before, I knew our 2 QA nurses. They would meet with us before TJC visited, and would meet with us when new standards came down. It was a very small facility. They also looked over incident reports to determine what could be changed, couldn't be changed and let us know

Where I work now I don't have a clue who our QA nurses are. Our CUE and Nurse manager gives us all the info we need. (CUE is clinical unit educator)

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I work for a major insurance company as a quality improvement nurse, meeting with providers and staff to assist with improving quality of care. Attribution has always been a problem. Today I was asked to move members (patients) from one physician to another. For some reason I don't feel comfortable doing this. Can anyone tell me if this would be a conflict of interest as an RN?

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Specializes in PICU, Sedation/Radiology, PACU.

I don't see how it could be a conflict of interest for you to reassign patients from one provider to another since you don't receive any benefits related to which provider the patients see. And if the providers are equally qualified there likely isn't any ethical reason not to reassign them either. However you might advise the facility that this is likely to decrease patient satisfaction and ultimately be counterproductive to their goals. You could recommend a different method of reallocating patients- such as asking for volunteers or assigning new patients only to the providers with the fewest patients.

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