Nurses as agents of quality improvement

There has been an information explosion in science and technology, an ageing of the population, changes in health financing, escalating public expectations of the quality of the services and a growing recognition of the need to deliver high quality, safe and effective health care to patients to attain better health outcomes. The shift to a growing population that is mobile, ageing and has (often multiple) chronic diseases, along with the menace of emerging and re-emerging infections are likely to be the major threats to the health of the global community. Nurses, like other health professionals, are rapidly rising to meet these complex challenges to thrive in the ever-changing health care environment. Over the years, Hong Kong's health system has experienced many changes, particularly in the areas of health and medical leadership, service landmarks and the political environment (Leong, 2002). Since the establishment of the Hospital Authority, changes have occurred in service organisation and provision, such as an improvement in clinical efficiency, the re-engineering and rationing of services, more visible accountability, and better teamwork (Leung, 2002). These changes have in turn influenced the restructuring of the nature and processes of nursing work, and have led to the development of new roles for nurses (Wong, 1998) and recognition of the need for a nursing workforce that has the competence to improve the health outcomes of patients. Leung (2002) suggested a paradigm shift in disease management strategies that involves the more integrated approach of including family education, the promotion of self-management, care process re-engineering, the adoption of evidence-based protocols and an infrastructure of information technology to support implementation and evaluation. The success of this framework requires the creation of an appropriate health care environment, but, more importantly, the collaborative efforts of a multidisciplinary team of health care professionals and a highly educated nursing workforce. This chapter highlights recent developments in the role of nursing in Hong Kong, the shortage of nurses and its implications, the need to invest in quality nursing education to achieve better health outcomes and the importance of a multidisciplinary effort to influence policy development.