Data will be collected daily for all new admissions for the first quarter (October 2008 to December 2008). This data will prove to be a baseline for future data collection. Future data collection will be done on a specific number of randomly selected patient charts. The data will be analyzed for discrepancies, patterns, and identification of staff members who needs additional education.

      The desired healthcare outcomes should be comparable to the background and knowledge base of the nursing staff. This is not to say that quality care cannot be achieved without outcomes being obtained. Staff can deliver poor care and quality of performance may be deemed as excellent. There are many indicators of quality care and outcomes measurement is only one. To use outcomes alone to measure quality care will produce data that is not valid and unreliable (Marquis & Huston, 2009).

Integrating Leadership

      To produce the quality of care needed to be considered an organization of excellence, a transformation of the culture of nursing staff must take place. This transformation must be one that promotes autonomy, and integrity. In order for the nursing staff to achieve this new behavior they must be led by a leader of change. If the CNL is to aid or lead the way in the transformation process there must first be a belief in their own mission, vision, roles and implementations for performance improvement. There are many roles that a leader must take into account and have the capability to live up to them. There is no contract that can be written that will eliminate all risk of integrity loss. A baseline requirement for leaders working to build a unit or organization is a necessary requirement. The staff may not understand every aspect of how or why the system is being developed, but if people believe that the leaders are honest and have their best interests at heart, they will generally be willing to support change. Conversely even the most brilliant scientific proposal will fall flat if led by an individual who is not regarded as having the highest integrity.

Marquis & Huston (2009) suggested the leadership roles include:

1. Encourages followers to be actively involved in the quality control process.

2. Clearly communicates expected standards of care to subordinates.

3. Encourages the setting of high standards to maximize quality instead of setting minimum safety standards.

4.  Embraces and champions quality improvement as an ongoing process.

5. Uses control as a method of determining why goals were not met.

6. Distinguishes between clinical standards and resource utilization standards, ensuring that patients receive at least minimally acceptable levels of quality of care.

7. Supports /actively participates in research efforts to identify and measure nursing sensitive patient outcomes (p. 538).

      Once the staff recognizes that the leader is one who holds all of these attributes, the leader will gain the trust of the staff and will then have buy-in into the performance improvement strategies that will prevent negative outcomes. Marquis & Huston (2009), suggested that “inspiring subordinates to establish and achieve high standards of care is a leadership skill. Leader’s role model high standards in their own nursing care and encourage subordinates to seek maximum rather than minimum standards” (p. 539).

Outcomes of Performance Measures

      The first data collection from the surgery unit was completed for the month of October 2008. The data showed that there were 76 admissions to the unit, 57 of these patients were surgical patients, and 19 patients were admitted for other reasons such as testing, observation, surgical workup, and overflow from other units. 30 patients required anticoagulant orders, and 46 patients required antibiotic orders, and 38 patients required TED and SCD orders. Only seven patients were ordered antibiotics that were administered improperly. The errors discovered in the data collection of the seven patients revealed that they received too many doses, too few doses or the doses were held causing a delay in the care of the patient. The other data that was collected was evaluated and deemed free of mistakes.

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