Week 2 Module- Policy, Legislation, Regulation, and Accreditation in
Quality and Safety
Required Readings
Institute for Healthcare Improvement. (n.d.). IHI open school continuing education creditsLinks to
an external site.. https://www.ihi.org/education/ihi-open-school/continuing-education-credits
QI 102: How to Improve with the Model for Improvement
PFC 101: Introduction to Patient-Centered Care
Shaw, P., & Carter, D. (2019). Quality and performance improvement in healthcare: Theory, practice,
and management (7th ed.). American Health Information Management Association.
Chapter 8: Refining the Continuum of Care
Chapter 16: Navigating the Accreditation, Certification, or Licensure Process
Advanced practice nurses play a crucial role in ensuring that healthcare services are delivered
effectively, safely, and efficiently. A comprehensive understanding of how legislation, regulation, and
accreditation impact care delivery is foundational to achieving these aims. Legislation and regulation
establish standards by safeguarding client rights and healthcare access while holding providers and
healthcare organizations accountable for their actions. Accreditation aids in improving quality and
safety by identifying areas that need improvement and promoting best practices among providers
and organizations. Advanced practice nurses must also possess a strong understanding of how
healthcare reimbursement is tied to quality and value measures to ensure effective and cost-efficient
care. These essential competencies are integral to advancing quality outcomes for clients and
populations.
1. Examine competencies and underpinnings to continuously improve the safety and quality of
healthcare.
2. Evaluate quality and safety initiatives to advance healthcare outcomes and equity across
healthcare settings.
3. Appraise ethical, legal, regulatory, and professional standards for quality management and
safety across healthcare settings. (POs 3, 4)
1. Policy, Legislation, Regulation, and Accreditation in Quality and Safety
Influence of policy
Influence of legislation
Regulatory agencies
Accreditation and recognition
2. Quality and Reimbursement
Reimbursement models
Value-based purchasing
3. Examine the impact of policy, law, regulation, and accreditation on quality and quality improvement
in healthcare. (COs 1, 2, 3)
4. Evaluate the relationship between value, quality, and reimbursement in healthcare. (COs 1, 2, 3)
Foundations for Learning
Start your week by reviewing the foundational concepts below. Foundational knowledge is
information you have previously learned through formal education, informal education, and life
experiences. Your ability to recall and apply this information is vital to your success as a student.
Review the activities below to refresh your memory and prepare to learn new content this week.
Magnet Recognition Program
Transformational Leadership
Quality of nursing leadership
This Management
study style
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Structural Empowerment
Organizational structure
Personnel policies and programs
Community and the healthcare organization
Image of nursing
Professional development
Exemplary Professional Practice
Professional models of care
Consultation and resources
Autonomy
Nurses as teachers
Interdisciplinary relationships
New Knowledge, Innovation, and Improvements
Quality improvement
Empirical Quality Results
Quality of care
Merit-based incentive payment system (MIPS)
Quality: Performance measures to assess the quality of care delivery
Promoting interoperability: Use of certified electronic health record technology to engage with
clients and colleagues
Improvement activities: Participation in activities to improve clinical practice and client
engagement
Cost: Assessment of cost based on Medicare Part B claims
Background
Healthcare expenditure in the United States (U.S.) amounts to over four trillion dollars annually, according to the
Centers for Medicare & Medicaid Services [CMS] (2022b). Consumers, healthcare employees, healthcare
organizations, insurers, and the government expect healthcare providers and organizations to meet specific quality
and safety standards when delivering care. Policy, regulation, and legislation are crucial in ensuring that healthcare
providers deliver safe, high-quality care by providing a legal framework for healthcare organizations to operate and
setting healthcare delivery standards.
Influence of Healthcare Policy
Healthcare policy is integral for safe, quality care. Public policies help guide the development of laws and regulations
that govern quality and safety in healthcare delivery (Centers for Disease Control and Prevention [CDC], n.d.-b).
Private policies like those developed by healthcare organizations help ensure compliance with legal and regulatory
requirements.
Influence of Policy on Quality and Safety Transcript
Standards and regulations: Determines standards, regulations, and reporting structures that
promote quality care and client safety and drive quality improvement initiatives.
Payment models: Influences payment models to incentivize the provision of high-quality care.
Client-centered care: Promotes client-centered care by encouraging client engagement and shared
decision-making and ensuring that client needs and preferences are considered.
Information technology: Promotes using information technologies such as electronic health
records and telehealth to improve the quality and safety of care by enabling providers to access and
share information more quickly and efficiently.
Influence of Legislation
Several key pieces of legislation have influenced quality and safety in healthcare.
The Patient Safety and Quality Improvement Act (PSQIA) of 2005 created a framework for
reporting and analyzing data about safety events such as medical errors and infections while
protecting client confidentiality (U.S. Department of Health and Human Services [HHS], n.d.-b). The
act established Patient Safety Organizations (PSOs) to collect and analyze information to identify and
address system-wide safety issues. The PSQIA also provided legal protections for healthcare
providers who report client safety events in good faith and authorized HHS to impose fines for
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confidentiality violations (HHS, n.d.-b).
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