1. The Evolving Role of the Quality Professional and Emerging Ethical Dilemmas AKA the “Texas Nurses Whistleblower Case”

2. What’s Happened So Far? Raised as an issue on the Board listserv Discussed informally at February Board meeting Discussed with several EAC members, with varying reactions Discussed at TJC NAC meeting Discussed on Team Leader call Definite interest! So what next?

3. Why Get Involved? Protect the integrity of our profession Raise awareness of the issues Influence policymakers on this issue Positioning/reinforcing NAHQ in a leadership role as related to issues of our profession

4. Environmental Scan - External Mandatory reporting of sentinel/serious adverse events P4P – increased reimbursement based on level of quality (i.e., adherence to core measures) HAC – decreased reimbursement based on “complications” Medical necessity enforcement – False Claims Act Expectations of public transparency & accountability – organizational and professional community reputation at risk

5. Environmental Scan - Internal Reduced budgets and operating margins Greater production pressure Reduced staffing “Bunker” mentality Vastly greater complexity Quickly changing rules Erosion of trust

6. Professional Dilemmas “Up-coding” quality performance Clinical/documentation workarounds Non-reporting of reportable events Medical necessity concerns unrecognized Issues with steep gradient of authority Non-functional peer review Outright harassment/intimidation

7. NAHQ’s Role

9. Six Characteristics of Professional Style Ethical AltruisticResponsible TheoreticalIntellectualCommitted Competence is a Given!

10. The Healthcare Quality Professional Safe work environment No compromises to data integrity Patient-centered practices Honesty & transparency Respect & trust Internal & external “chain of command” to properly address concerns Protection from retribution or harassment

11. NAHQ’s Role Establishing code of ethics Establishing standards of practice Identifying & examining emerging practice issues Providing a professional framework and guidance (i.e., through position statements) Providing opportunities for professional development Assuring value of the profession to society

12. Proposed Next Steps Board: Formal NAHQ Charter needed – task team STOP calling it the “Texas Nurses” case! o MUCH broader than that o This case was only the triggering event o Do not want the broader discussion to bog down on opinions about the facts and merits of this particular case Team: Identify implications for NAHQ o Environmental scan o Scope & objectives – what is it that we want to change? Identify partners – NAHQ as convener, to address NAHQ issues, but also to address issues brought by panel members from outside of NAHQ With Board approval, convene a panel to identify all the issues and recommend an action plan/deliverables