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QI measures and strategies, and use information technology (Greiner and Knebel, 2003). Nursing, however, has been the only profession to establish a comprehensive framework to integrate the six competencies across all educational programs through the QSEN project funded by the Robert Wood Johnson Foundation (Cronenwett et al., 2007; Cronenwett et al., 2009): patient‐centered care, teamwork and collaboration, evidence‐based practice, quality improvement, safety, and informatics.

Table 1.1 Themes Defining Safer Together: A National Safety Plan

Theme	Attributes
Culture, Leadership, and Governance	Leveraging health care leadership and governance to commit to safety as a core value and drive creation of strong organizational cultures is a pillar for improving safety and quality. These are key drivers in hospital quality indicators hardwired across the system (Breyer et al., 2019; Brooks Carthon et al., 2019).
Patient and Family Engagement	The goal to commit to fully engaging patients, families, and care partners in all aspects of care at all levels is a priority of twenty‐first‐century health care. Patient and family engagement are key to improving health care outcomes by helping them become active in their care to share in decision‐making (Hatlie et al., 2020).
Workforce Safety	Workforce safety is listed separately from patient safety to separate management strategies. Commitment to workforce wellness protects physical, psychological, and emotional safety and builds supportive structures for worker health.
Learning Systems	The goal of the learning system recommendations is building commitment to continuous learning in an integrated learning system within organizations by creating and strengthening informatics, transparency, reliability, and network sharing. Organizational learning is the way for hospitals to measure outcomes, reflect on the results, and design purposeful high‐quality patient care within a complex, dynamic health care environment (Lyman, Gunn, and Mendon, 2020).

      QSEN: Taking the Lead for Patient Safety and Quality

      The QSEN project goals in the United States (www.qsen.org) is to (a) change the mindset of nurses to a practice based on inquiry in which questions focus on how to continuously improve care; (b) develop and use evidence‐based standards and interventions; (c) investigate outcomes and critical incidents from a system perspective; and (d) work in intra‐ and interprofessional delivery teams (Cronenwett et al., 2007; Cronenwett et al., 2009; Sherwood, 2011). Increasingly, other countries are reporting efforts to integrate safety and quality in nursing curricula (Steven et al., 2019).

The six competencies are not isolated concepts, but are interrelated and apply across all health disciplines, with expectations after 15 years that new graduates will have developed the QSEN competencies (Forbes et al., 2020). Brief descriptions of the competencies are provided in Textbox 1.5 and Table 1.2, complete definitions and the KSAs can be found in Appendices A and B, and each competency is discussed in separate chapters in Section 2 of this book.

The QSEN competencies cross‐reference with the four IPEC domains described earlier: roles and responsibilities, teamwork, communication, and ethics and values, with interprofessional collaboration an overarching theme (IPEC, 2011, 2016). All fit within the TeamSTEPPS curriculum (https://www.ahrq.gov/teamstepps/about‐teamstepps/index.html), as illustrated in Figure 1.4. Together, these competencies are key parts of developing new generations of health professionals with a mindset for improving quality and safety working in collaborative interprofessional teams (see Chapters 10 and 12).

Table 1.2 Descriptions of Six QSEN Competencies^*

Patient‐centered care	In patient‐centered care, patients and their families are treated with respect and honor, engaged as partners in their care, treated as safety allies, and participate in shared decisions that are made based on knowledge of patient values, beliefs, and preferences (see Chapter 4). Sharing knowledge and information with patients and families enables their participation in the team and decisions about their care.
Teamwork and Collaboration	Working together effectively continues to account for many preventable harm events. Interprofessional education experiences can promote more transparent, effective communication that helps coordinate patient care. Coordinating complex care requires cross‐disciplinary communication, knowing the scope of responsibility, and organizational support for speaking up when safety is compromised (IPEC, 2011, 2016). Developing emotional intelligence can help health professionals use their strengths to contribute to effective team functioning, leadership, effective communication, mutual support, and situational awareness (see Chapters 5 and 16).
Evidence‐Based Practice	Evidence‐based practice blends skills in informatics to seek current evidence, bases decisions on patient preferences and values as part of patient‐centered care, and informs areas for quality improvement to measure actual practice to compare with benchmark data to determine areas to improve (see Chapter 7). Reflective practice develops a spirit of inquiry by asking questions about the care that was delivered.
Quality Improvement	A mindset of continuously improving care reflects a spirit of inquiry. Quality improvement measures variance in ideal and actual care and implements strategies to close the gap (see Chapter 6).
Safety	Safety science redirects the examination of errors from blaming the person to one that examines the system in which the error occurred. A systems approach examines the conditions in the environment that may have contributed to the error and designs defenses to prevent errors or mitigate effects, always asking where the next error is likely to occur and taking actions to prevent it (see Chapter 8).
Informatics	Nurses need to be involved in designing and implementing informatics in electronic health records, decision support tools, and safety alerts (see Chapter 9). Providers retrieve information, search for latest evidence, manage quality improvement data and strategies, and share information across the interprofessional team.

      ^* Appendices A and B have definitions with the 162 knowledge, skill, and attitude objective statements.

Evolving Nurses' Roles

      Clinicians in all levels and areas of health care should have goals for improving quality and safety, yet nurses are at the forefront. The 2010 report, The Future of Nursing: Leading Change,

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