The Five Guiding Principles

1. Healthcare Quality and Patient Safety

  • Ensure that quality and safety topics are high-priority, visible efforts of healthcare leadership.
  • Integrate proven patient safety strategies into healthcare processes of care.
  • Monitor and report progress on efforts to improve quality of care and patient safety.
  • Measure improvement over time on specific endeavors.

2. Providing Staffing that Meets Patient Needs

  • Under PatientCareLink, (PCL), hospitals voluntarily make staffing plans available to patients and the public and post them on the PCL website. This annual plan describes staffing in each hospital clinical unit (adult critical care, adult step-down, adult medical, adult surgical, adult medical/surgical combined and emergency department) by shift. The plan also describes the factors that nurse leaders must consider in determining how to care for each patient and provides information on care provided on an "hours per patient day" basis. Nurse leaders who are responsible for putting the plan together gather information and advice from nurses and others providing care to patients.
  • Hospitals also file an annual aggregate report on their plans, to show how they were actually carried out. These reports include an explanation of appropriate actions taken if there are significant variations from the original annual plan.

3. Making Healthcare Data and Performance Measures Transparent and Publicly Available

  • Hospitals and home care agencies have committed to a common framework of measurement and data reporting. Hospitals have been publicly reporting as many as seven of the same nursing-sensitive, evidence-based measures selected from the National Quality Forum, including "worked hours per patient day" (WHPPD).
  • Hospitals and home health agencies have been reporting information on how well hospitals and home health agencies care for patients.  These performance measures from Hospital Compare and Home Health Compare are posted on PCL.   Via the PCL web site and individual hospital and home health outreach, educate the public about what hospitals and home care agencies are doing to ensure and improve safe care.
  • Forge partnerships among healthcare organizations and with leaders of business, government, consumer groups, and others to promote access to high-quality, safe care for all. Such efforts include expanding health insurance coverage, sustaining the capacity of the healthcare system to deliver care, and identifying ways to assist providers of care to obtain and deploy new technologies to advance patient safety.

4. Workforce Development

  • Create hospital and home health-based initiatives and strategic partnerships to tackle the chronic problem of shortages of nurses and other care professionals. Efforts include in-house education programs, innovative "career ladders," mentoring and preceptor opportunities, joint funding of nurse faculty positions in educational institutions, and expanding clinical training sites.
  • Support government-based initiatives to develop and maintain a solid corps of dedicated healthcare care professionals in addition to "in-house" endeavors. Examples include supporting the Nursing Compact and supporting supply-side legislation such as scholarships, loan forgiveness, and incentives for primary care.

5. Promoting a Safe, Respectful and Supportive Working Environment 

  • Undertake externally recognized programs that support performance excellence, such as Lean and Six Sigma, the American Nurses Credentialing Center "Magnet" hospital designation and the Malcolm Baldrige National Quality Program, and/or adopt the principles that support such programs.
  • Support legislation to protect all hospital, home health, and other provider employees from workplace violence.
  • Work with other healthcare leaders to study the effects of fatigue on human performance in healthcare settings and identifying strategies to address the issue.
  • Monitor progress of efforts to improve the work environment.  Examples of such 'practice environment assessments' include surveying caregivers and measuring improvement over time on specific employee satisfaction endeavors.  These also include feasible alternatives to mandatory overtime and identification of ways to manage patient care without its use.