Strategies to advance health care quality

Overcoming the quality crisis in American health care is an enormous challenge. Despite a large cadre of individuals committed to improving quality, progress is stifled by the multiple ways in which issues central to quality care are conceptualized. To realize bona fide improvements in care quality, it is essential to understand the dominant conceptualizations driving quality efforts. Steps must then be taken to revise those conceptualizations that are obstacles to advancing health care quality. In this paper, four strategies are proposed for refocusing quality initiatives: (1) Looking at quality from the cliniciansʹ eyes, (2) moving beyond physician care as a synonym for quality, (3) expanding the triple typology used to classify quality, and (4) enriching the evidence base for quality. The paper concludes with a call to action for nurses to exert stronger leadership to advance quality.