MSN560 University Access Cost and Quality for APNs Discussion: The Quality Environment

Beginning with Florence Nightingale, nursing has always given attention to quality issues. Despite our historical roots as leaders in this area, the profession has drifted to a more internal, narrow perspective. Until recently, this mirrored the attention our society gave to the quality of health care.

In the United States especially, the values of individualism and self-determination, science and technology, a disease and medical focus, the free-market economy, and nongovernmental interference shaped both the structures and processes of the health-care system, thus influencing its outcomes. Access and cost issues have, until recently, received more attention than quality, particularly at the societal level.

As cost concerns increased and new delivery systems—such as managed care—were implemented, greater attention focused on quality and value. In addition, industry and quality theories and practices in business suggested that lessons learned in these arenas could be applied to the health-care sector. 370 Unit 4 • Ethical, Legal, and Business Acumen practice behavior, collaboration, and APN satisfaction.

The outcomes related to APN structures and processes include mortality, morbidity, patient knowledge, patient satisfaction, service use, and health status. Quality of care can be viewed from a micro or macro perspective. At the micro level, quality is conceptualized and assessed for the patient, the provider, or the institution. Clinical and technical care, satisfaction with care, and quality of life represent components of a micro view (Shi & Singh, 2005).