Quality improvement: the divergent views of managers and clinicians.

AIM: The aim of this study was to identify and explore nurse managers' and clinical nurses' perceptions of quality improvement as related to their practice.

BACKGROUND: The quality improvement process has become an integral component of health care service delivery. The pivotal role that nurse managers and clinical nurses play in the success of quality improvement initiatives is consistently reported throughout the literature. Published evidence has primarily focused on nurses' perceptions of "quality" and the importance of the nurse's role. However, the literature fails to provide evidence that nurse managers and clinical nurses agree with this.

METHOD: Research was conducted at one large regional hospital in Australia in the year 2000 and used a descriptive qualitative research methodology. Data were collected using semistructured interviews with six nurse managers and six clinical nurses on two consecutive occasions and analysed using constant comparative analysis.

RESULTS: Nurse managers' and clinical nurses' understanding of the concept of quality improvement and how it applies to the practice of nursing differed. Each group identified that quality improvement can be beneficial to nursing practice, but blamed each other for potential benefits not being realized. Both nurse managers and clinical nurses offered similar solutions with varied emphasis on how quality improvement could improve nursing practice and patient outcomes.

CONCLUSION: The quality improvement process requires review. Nurse managers and clinical nurses offered divergent views of the identified deficiencies in the way quality improvement is implemented that reduce its clinical impact. Integral to the success of any quality improvement process is the inclusion of views of both nurse managers and clinical nurses.