**4. Describe the role of quality as an outcome measure for innovation efforts**

Reflecting on the definition provided at the start of the chapter, innovation is a new product, process, and/or service that addresses a pervasive unmet need for a population of people to support optimal healthcare quality. Innovations introduced into healthcare settings must work to improve care quality. Improving care quality is not necessarily a requirement for non-nursing and/or non-healthcare innovations. However, with regulatory requirements, ethical considerations, and more, nurse innovators will increase their likelihood of innovation adoption and use with clarity around how quality of care can be improved through the innovation.

### **4.1 Quality**

In 2000, the Institute of Medicine (IOM) (now the National Academy of Medicine (NAM)) published the seminal report, Crossing the Quality Chasm [39]. Within that report, healthcare quality was defined as "the degree to which healthcare services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge" [40]. More specifically, quality was broken into six different domains. The six quality domains are: safe, efficient, effective, equitable, patient-centered, and timely. Each attribute is defined below as described by the IOM (now NAM).

### *4.1.1 Safe*

Safe care is care that is free from any unintended injury, harm, or error [40]. Nurses and healthcare professionals have an ethical expectation to provide care void of any intentional harm or negligence. While an ethical expectation, there are times when errors do occur. Therefore, one domain of quality is to promote and establish safe care practices, policies, and solutions to reduce the risk of unintended injury, harm, or error to others.

### *4.1.2 Efficient*

Efficient care is care that avoids unnecessary waste and/or costs [40]. Unnecessary waste and/or costs could apply to tangible and intangible items. Tangible waste and/or costs could be medical supplies, exams, tests, procedures, and visits. Intangible waste could be unnecessary wait times, delays, and/or interruptions to care delivery. While not intentional, any lack of efficiency around the unnecessary waste and/or costs has room for improvement toward optimal care quality.

### *4.1.3 Effective*

Effective care integrates evidence-based practice into the care delivery process [40]. Care delivery is largely evidence-based. The evidence-based protocols are based on research outcomes and analysis to determine the most effective procedures and protocols to achieve optimal health outcomes for the affected people. Yet, new evidence-based practice protocols and procedures evolve as patients' responses indicate the need for new tools to reach a desired outcome.

### *4.1.4 Equitable*

Equitable care is care that is optimally delivered to all people, regardless of gender, ethnicity, geography, socioeconomic status, and more [40]. Every person is deserving of nursing and healthcare that is equitable. However, evaluation of one's social determinants of health may indicate that there are additional care needs to include and/or adjust to deliver equitable care.

### *4.1.5 Patient-centered*

Patient-centered care focuses on individualizing care to the specific patient [40]. Every patient is a person who has personal preferences and clinical preferences for care [41]. Patients are people first with clinical and personal care needs. Patients want to be treated like a person and not a protocol or diagnosis. Patients have unique insights that must be considered for patient-centered care by nurses and healthcare professionals.

### *4.1.6 Timeliness*

Timeliness of care is care that is delivered without delays [40]. Nurses and healthcare professionals aim to deliver care in a timely manner (void of delays). However, most nurses, healthcare professionals, and patients are aware of instances of delayed care. Delayed care could be the wait time for an available appointment, emergency room wait time and/or time to be admitted or discharged.

### **4.2 Quality influencing nursing and healthcare innovation**

With these six domains of quality, innovators can begin to work backwards with the six domains of quality as the starting place for consideration and exploration of unmet needs affecting a population of users. The population of users could be nurses, patients, family members, groups, communities, all people and/or any other subgroup. The unmet need(s) to identify as an innovator is(are) gaps or limitations in care delivery related to at least one of the six domains: safe, efficient, effective, equitable, patient-centered, and timeliness.

To identify potential opportunities for innovation, consider where there are specific current gaps and/or limitations in care delivery. Once that gap and/or

limitation is identified, consider what the implications are for care quality. Go back to the definitions above and identify how that gap and/or limitation is not fully fulfilling the expectation of the domain (or domains if more than one identified). By identifying the gap in quality through one or more of the domains, there is the opportunity to measure the impact of the gap and subsequently the impact of the forthcoming innovation. Next, use the principles of innovation theory and design thinking methodology [42] to formulate an idea and process to develop an innovative solution, prototype, and plan for bringing to the market and/or society.
