Chapter 1 Establishing Credibility © 2021 McGraw Hill. All rights reserved. Authorized only for instructor use in the classroom. No reproduction or further distribution permitted without the prior written consent of McGraw Hill. Because learning changes everything.® 1 Learning Objectives 1.1 Explain the importance of establishing credibility for business communications. 1.2 Describe how competence, caring, and character affect your credibility as a communicator. 1.3 Define and explain business ethics, corporate values, and personal values. 1.4 Explain the FAIR approach to ethical business communications. © McGraw Hill 2 Why Does This Matter? Credibility Your reputation for being trustworthy. The degree to which others believe or trust in you. © McGraw Hill Credibility is your reputation for being trustworthy—trustworthy to perform your work with excellence; to care about those you work with and for; to live by high ethical, corporate, and personal values; and to deliver on your promises. In short, your credibility is the degree to which others believe or trust in you. 3 The Role of Trust in the Post-Trust Era 1 What should you do when communicating? Operate from a position of trust or credibility. Gain trust or credibility from colleagues, clients, customers, and other contacts. © McGraw Hill Do you operate from a position of trust or credibility? That is one of the first things you should consider as you communicate. In the business world, you often start from a deficit of trust. As a result, one of your first goals should be to gain trust or credibility from colleagues, clients, customers, and other contacts. 4 The Role of Trust in the Post-Trust Era 2 The Public Increasingly views companies with less trust. Companies Also have a deficit of trust. Employees often do not trust their own business leaders. © McGraw Hill The public also increasingly views companies with less trust. Approximately 85 percent of senior executives surveyed believe that public trust in business has gone down. A deficit of trust also exists within companies. Various surveys show that employees often do not trust their own business leaders. Just 51 percent of employees trust senior management, and only 36 percent of employees believe that their company leaders act with honesty and integrity. Furthermore, approximately 76 percent of employees have seen illegal or unethical conduct in the past 12 months at their jobs. 5 Figure 1.1 A Look at Trust in Various Professions Access the text alternative for slide images. Source: Gallup, Inc. © McGraw Hill As depicted in Figure 1.1, the trust extended by the general public to business executives is far lower than the trust extended to members of other selected professions. Note: Based on the percentage of American adults who considered members of these occupations “very high” or “high” in honesty and ethical standards in a November 2017 Gallup poll. Available at news.gallup.com/poll/224.

1. Chapter 1
Establishing Credibility
© 2021 McGraw Hill. All rights reserved. Authorized only for
instructor use in the classroom.
No reproduction or further distribution permitted without the
prior written consent of McGraw Hill.
Because learning changes everything.®
1
Learning Objectives
1.1 Explain the importance of establishing credibility for
business communications.
1.2 Describe how competence, caring, and character affect
your credibility as a communicator.
1.3 Define and explain business ethics, corporate values, and
personal values.
1.4 Explain the FAIR approach to ethical business
communications.
© McGraw Hill
2
Why Does This Matter?

2. Credibility
Your reputation for being trustworthy.
The degree to which others believe or trust in you.
© McGraw Hill
Credibility is your reputation for being trustworthy—
trustworthy to perform your work with excellence; to care about
those you work with and for; to live by high ethical, corporate,
and personal values; and to deliver on your promises. In short,
your credibility is the degree to which others believe or trust in
you.
3
The Role of Trust in the Post-Trust Era 1
What should you do when communicating?
Operate from a position of trust or credibility.
Gain trust or credibility from colleagues, clients, customers,
and other contacts.
© McGraw Hill
Do you operate from a position of trust or credibility? That is
one of the first things you should consider as you communicate.
In the business world, you often start from a deficit of trust. As
a result, one of your first goals should be to gain trust or
credibility from colleagues, clients, customers, and other
contacts.
4
The Role of Trust in the Post-Trust Era 2
The Public
Increasingly views companies with less trust.
Companies

3. Also have a deficit of trust.
Employees often do not trust their own business leaders.
© McGraw Hill
The public also increasingly views companies with less trust.
Approximately 85 percent of senior executives surveyed believe
that public trust in business has gone down. A deficit of trust
also exists within companies. Various surveys show that
employees often do not trust their own business leaders. Just 51
percent of employees trust senior management, and only 36
percent of employees believe that their company leaders act
with honesty and integrity. Furthermore, approximately 76
percent of employees have seen illegal or unethical conduct in
the past 12 months at their jobs.
5
Figure 1.1 A Look at Trust in Various Professions
Access the text alternative for slide images.
Source: Gallup, Inc.
© McGraw Hill
As depicted in Figure 1.1, the trust extended by the general
public to business executives is far lower than the trust
extended to members of other selected professions.
Note: Based on the percentage of American adults who
considered members of these occupations “very high” or “high”
in honesty and ethical standards in a November 2017 Gallup
poll. Available at news.gallup.com/poll/224639/nurses-keep-
healthy-lead-honest-ethical-profession.aspx.
6

4. The Role of Trust in the Post-Trust Era 3
Post-Trust Era
The public overwhelmingly views businesses as operating
against the public’s best interests.
Most employees view their leaders and colleagues with
skepticism.
© McGraw Hill
In the post-trust era, the public overwhelmingly views
businesses as operating against the public’s best interests, and
the majority of employees view their leaders and colleagues
with skepticism. Regarding the post-trust era, Michael
Maslansky, a leading corporate communications expert, said,
“Just a few years ago, salespeople, corporate leaders, marketing
departments, and communicators like me had it pretty easy. We
looked at communication as a relatively linear process.… But
trust disappeared, things changed.”
7
Figure 1.2 The Three Components of Credibility
© McGraw Hill
As a future manager and executive, you can control your
reputation as a credible communicator by focusing on three
well-established factors: competence, caring, and character.
Research has shown that these three factors almost entirely
account for whether a person is considered credible in
professional situations. As depicted in Figure 1.2, credibility is
like a three-legged stool. Without any one element, it is

5. compromised.
8
The Role of Competence in Establishing Credibility 1
Competence
The knowledge and skills needed to:
Accomplish business tasks.
Approach business problems.
Get a job done.
Most people will judge your competence based on your track
record of success and achievement.
© McGraw Hill
Competence refers to the knowledge and skills needed to
accomplish business tasks, approach business problems, and get
a job done. Most people will judge your competence based on
your track record of success and achievement. In her memoir,
Meg Whitman explains how as a young professional she gained
credibility and displayed competence within her organization: “I
just focused on delivering results,” she said. “You have to excel
at the tasks you’re given and you have to add value to every
single project, every conversation where someone seeks your
input.”
9
The Role of Competence in Establishing Credibility 2
How Do You Establish Competence?
Through study, observation, and practice and real-world
business experiences.
In the ways you communicate with others.
© McGraw Hill

6. People develop competence in many ways: through study,
observation, and, most importantly, practice and real-world
business experiences. Your entire business program is likely
centered on developing competence in a certain business
discipline or industry. You may already have significant
business experience. If you’re a novice, seeking internships and
jobs related to your discipline will help you develop
competence. How you communicate directly affects how others
perceive your competence.
10
The Role of Competence in Establishing Credibility 3
Focus on Action
Emphasis on Results
© McGraw Hill
Throughout this book, you will find an emphasis on two traits
associated with competence: a focus on action and an emphasis
on results. A focus on action implies that you seize business
opportunities. Meg Whitman emphasized this action-oriented
approach to work: “The way I usually put it is, the price of
inaction is far greater than the cost of making a mistake. You do
not have to be perfect to be an effective leader, but you cannot
be timid.” She also described an emphasis on results: “I don’t
believe that all a company needs to do is declare that it has
values and then say, ‘Trust us, we know what’s best.’ To be a
success, you must identify a goal with a measurable outcome,
and you must hit that goal—every day, every month, every
year.”
11
The Role of Caring in Establishing Credibility 1
Caring

7. Understanding the interests of others.
Cultivating a sense of community.
Giving to others and showing generosity.
© McGraw Hill
Your colleagues, clients, and even your customers will trust you
far more if they know you care about them. As Mahatma Gandhi
once stated, “The moment there is suspicion about a person’s
motives, everything he does becomes tainted.” This statement
applies in nearly all business circumstances: In the business
world, caring implies understanding the interests of others,
cultivating a sense of community, and giving to others and
showing generosity. People distrust individuals who are
perceived as unconcerned about the interests of others or
disinterested in causes above and beyond themselves.
12
The Role of Caring in Establishing Credibility 2
Understanding the Interests of Others
To gain credibility, show that you care for the needs of others.
Connect with others to gain trust.
Understand others’ needs, wants, opinions, feelings, and
aspirations.
Develop an other-orientation.
© McGraw Hill
Your ability to gain credibility strongly depends on your ability
to show that you care for the needs of others. Furthermore, your
ability to show you care puts you in a rare position as a
business leader. After all, less than half (42 percent) of
employees believe that their managers care about them.
Effective communicators gain trust by connecting with others—

8. that is, seeking to understand others’ needs, wants, opinions,
feelings, and aspirations. Virtually every aspect of
communication you will focus on in this book relies on this
other-orientation.
13
The Role of Caring in Establishing Credibility 3
The Importance of a Sense of Community and Teamwork
Effective corporate business leaders recognize this.
Communicate using a “we” and “you” orientation.
Engenders trust and helps you find mutually beneficial
solutions.
© McGraw Hill
The most effective business leaders in today’s corporate
environment have generally risen to their positions because of
their sense of community and teamwork. Throughout this
textbook, you will see techniques for communicating your “we”
and “you” orientation rather than a “me” orientation. Speaking
about “our needs” or “your needs” as opposed to “my needs”
engenders trust and helps you come up with solutions that
achieve mutual benefit.
14
The Role of Caring in Establishing Credibility 4
Giving to Others and Showing Generosity
Companies with higher percentages of givers have higher
profitability, higher productivity, higher customer satisfaction,
and lower turnover.
Being a giver opens up opportunities.
© McGraw Hill

9. Recent research has shown that most professionals can broadly
be characterized as givers and takers. Givers are those
professionals who go out of their way to help colleagues,
respond to their requests and needs, and generously support
others in the workplace. Takers are those professionals who
frequently ask for favors from colleagues yet infrequently
volunteer to help their peers in return. Dozens of studies in
recent years show that organizations with more generous and
giving employees perform better. Such companies achieve
higher profitability, higher productivity, and higher customer
satisfaction.
15
The Role of Character in Establishing Credibility 1
Character
Staying true to commitments made to stakeholders.
Adhering to high moral and ethical values.
Central to creating trust.
© McGraw Hill
Character refers to a reputation for staying true to commitments
made to stakeholders and adhering to high moral and ethical
values. Character has always been important in business
relationships, especially long-term, collaborative relationships.
It is becoming even more important—especially for leaders—in
an increasingly open, transparent, connected, and
interdependent workplace.
16
Figure 1.3 What Determines Trust in Individuals in the
Workplace?
Access the text alternative for slide images.

10. Source: Economist Intelligence Unit.
© McGraw Hill
Character is central in creating trust. Consider the recent
research, depicted in Figure 1.3. Business executives were
asked what the most important determinants of trust in
workplace projects were. Overwhelmingly, character-based
traits—that is, honesty, ethical behavior, willingness to
exchange information—ranked at the top.
17
The Role of Character in Establishing Credibility 2
Business Ethics
The commonly accepted beliefs and principles in the business
community for acceptable behavior.
Adhering to laws.
Safeguarding confidential or proprietary information.
Avoiding conflicts of interest and misuse of company assets.
Refraining from accepting or providing inappropriate gifts,
gratuities, and entertainment.
Transparency is important in corporate communications.
© McGraw Hill
Business ethics are the commonly accepted beliefs and
principles in the business community for acceptable behavior.
At a minimum, business ethics involve adhering to laws;
safeguarding confidential or proprietary information; avoiding
conflicts of interest and misuse of company assets; and
refraining from accepting or providing inappropriate gifts,
gratuities, and entertainment.
Transparency involves sharing all relevant information with
stakeholders. As defined by Transparency International,

11. transparency “is a principle that allows those affected by
administrative decisions, business transactions or charitable
work to know not only the basic facts and figures but also the
mechanisms and processes. It is the duty of civil servants,
managers and trustees to act visibly, predictably and
understandably.” You will soon be in leadership positions
within your organization. You can create a transparent
workplace by being accessible, acknowledging the concerns of
others, and following through when you don’t have immediate
answers.
18
The Role of Character in Establishing Credibility 3
Trust-building behaviors include:
Extending trust.
Sharing information.
Telling it straight.
Providing opportunities.
Admitting mistakes.
Setting a good example by following rules.
© McGraw Hill
Trust-building behaviors include extending trust, sharing
information, telling it straight, providing opportunities,
admitting mistakes, and setting a good example by following
rules.
19
The Role of Character in Establishing Credibility 4
Corporate and Personal Values
Corporate values:
Stated and lived values of a company.
Personal values:
Values that individuals prioritize and adhere to.

12. © McGraw Hill
Corporate values are the stated and lived values of a company.
The Society for Human Resource Management espouses
corporate values as the essence of business ethics. It defines
business ethics as “organizational values, guidelines, and
codes,” and it emphasizes “behaving within those boundaries
when faced with dilemmas in business or professional work.”
Personal values are those values that individuals prioritize and
adhere to.
20
The Role of Character in Establishing Credibility 5
Code of Conduct or Code of Ethics
Sarbanes-Oxley Act of 2002 requires publicly traded companies
to have a code of ethics available to all employees and to ensure
that it is enacted.
© McGraw Hill
Most organizations have created a written code of conduct or
code of ethics. Publicly traded companies are required by the
Sarbanes-Oxley Act of 2002 to have a code of ethics available
to all employees and to ensure that it is enacted. For example,
eBay’s culture of trust is embodied in its Code of Business
Conduct & Ethics. It encourages employees that “beyond
complying with the law… [they] can Do the Right Thing.” It
encourages them to “be open, honest and direct and conduct
business with integrity” and “encourage open communication
free from the threat of retaliation.” Aligning personal values
with corporate values is an important element of character.
After all, if one is living corporate values that do not match
one’s personal values, then there is a lack of integrity.

13. 21
The Role of Character in Establishing Credibility 6
Open and Honest Communication
Avoid open and honest communication of business problems,
employees doom a business to poor financial performance.
Dishonesty is among the primary reasons for lower employee
morale.
Dishonesty can be reason for dismissal.
© McGraw Hill
By avoiding open and honest communication of business
problems, employees doom a business to poor financial
performance. Also, dishonesty is among the primary reasons for
lower employee morale. Nearly six in ten employees say that
they’ve left an organization because of lack of trust—the key
reasons being lack of communication and dishonesty. Finally,
dishonesty can be reason for dismissal. In some cases,
dishonesty can destroy careers and even result in criminal
charges.
22
The Role of Character in Establishing Credibility 7
A Stakeholder View of Accountability
Implies an obligation to meet the needs and wants of others.
Involves an enlarged vision of those affected by your business
activities.
Takes a stakeholder view that includes all groups in society
affected by your business.
© McGraw Hill
A sense of accountability implies an obligation to meet the

14. needs and wants of others. It also involves an enlarged vision of
those affected by your business activities. It takes a stakeholder
view that includes all groups in society affected by your
business activities. Thus, a sense of accountability involves a
feeling of responsibility to stakeholders and a duty to other
employees and customers. By placing a rationale for
accountability in your communications, you will generate
substantial trust and goodwill from others.
23
The Role of Character in Establishing Credibility 8
Fairness in Business Communications
The FAIR test helps you examine how well you have:
Provided the facts.
Granted access to your motives, reasoning, and information.
Examined impacts on stakeholders.
Shown respect.
© McGraw Hill
The FAIR test helps you examine how well you have provided
the facts; how well you have granted access to your motives,
reasoning, and information; how well you have examined
impacts on stakeholders; and how well you have shown respect.
As you respond to these questions, you ensure that your
communications are fair to yourself and others.
24
Figure 1.4
The FAIR Test of Ethical Business Communication
Access the text alternative for slide images.

15. © McGraw Hill
In all your communications, you should consider whether you
are being fair to others. For routine communications, you make
this calculation quickly. For important, less straightforward,
and perhaps even controversial communications, you should
spend a significant amount of time evaluating the best way to be
fair. You might consider talking to your supervisor, peers, and
other trusted individuals to appraise the situation.
25
How You Can Improve Your Communication Skills
Establishing credibility will help you build high-trust
relationships and communicate more effectively.
This textbook is designed to help you improve your
communication skills.
© McGraw Hill
Establishing credibility allows you to communicate more easily
and more influentially. Extensive research has shown that high-
trust relationships lead to more efficient and superior work
outcomes. In terms of ease of communication, credibility leads
to less resistance from others, increased willingness to
cooperate, and less likelihood of miscommunication. In high-
trust relationships, since individuals willingly and freely give
the benefit of the doubt, communication is simpler, easier,
quicker, and more effective.
26
Figure 1.5 Overview of Book
Access the text alternative for slide images.

16. © McGraw Hill
This textbook is designed to help you improve your skills in a
variety of professional settings so that you can become a
credible and trusted communicator. Overall, you may feel that
you excel at some communication skills but not others.
Regardless of your present skill level, this textbook gives you
opportunities to deliberately and consciously elevate your
communication skill set. It also gives you tools to continue
developing your communication abilities over the course of
your career. Figure 1.5 provides an overview of the topics we
will cover in this textbook.
27
Business Communication: Developing Leaders for a Networked
World, 4e
Chapter 1
© 2021 McGraw Hill. All rights reserved. Authorized only for
instructor use in the classroom.
No reproduction or further distribution permitted without the
prior written consent of McGraw Hill.
Because learning changes everything.®
www.mheducation.com
© McGraw Hill
Accessibility Content:
Text Alternatives for Images
© McGraw Hill

17. Figure 1.1 A Look at Trust in Various Professions – Text
Alternative
Return to parent-slide containing images.
Trust is indicated from zero percent (low trust) to 100 percent
(high trust). From highest to lowest, the professions are: nurses
at 82 percent; military officers at 71 percent; grade school
teachers at 66 percent; medical doctors at 65 percent;
pharmacists at 62 percent; police officers at 56 percent; clergy
at 42 percent; auto mechanics at 31 percent; newspaper
reporters at 25 percent; bankers at 25 percent; lawyers at 18
percent; business executives at 16 percent; advertising
practitioners at 12 percent; car salespeople at 10 percent; and
lobbyists at 8 percent.
Return to parent-slide containing images.
© McGraw Hill
Figure 1.3 What Determines Trust in Individuals in the
Workplace? – Text Alternative
Return to parent-slide containing images.
From highest to lowest, the character-based traits most
important to business executives were: honesty, 77 percent;
ethical behavior, 68 percent; exchanges information willingly,
63 percent; shared objectives, 53 percent; respectfulness toward
others, 49 percent; expertise, 42 percent; positive attitude, 40
percent; motivation, 39 percent; consideration of others, 37
percent; ability to do the job well, 36 percent; communication
skills, 36 percent; intelligence, 29 percent; experience, 23
percent; connectedness, 17 percent; and works for a reputable
company, 12 percent.
Return to parent-slide containing images.
© McGraw Hill

18. Figure 1.4 The FAIR Test of Ethical Business
Communication – Text Alternative
Return to parent-slide containing images.
Facts. How factual is your communication? Have you presented
the facts correctly? Have you presented all the relevant facts?
Have you presented any information that would be considered
misleading? Have you used the facts in a reasonable manner to
arrive at your conclusions and recommendations? Would your
audience agree with your reasoning?
Access. How accessible or transparent are your motives,
reasoning, and information? Are your motives clear, or will
others perceive that you have a hidden agenda? Have you fully
disclosed how you obtained the information and used it to make
your case? Are you hiding any of the information or real
reasons for making certain claims or recommendations? Have
you given stakeholders the opportunity to provide input in the
decision-making process?
Impacts. How does your communication impact stakeholders?
Have you considered how your communication impacts all
stakeholders? Have you thought about how your communication
will help or even hurt others? How could you learn more about
these impacts?
Respect. How respectful is your communication? Have you
prepared your communication to recognize the inherent dignity
and self-worth of others? Would those with whom you are
communicating consider your communication respectful? Would
a neutral observer consider your communication respectful?
Return to parent-slide containing images.
© McGraw Hill
32

19. Figure 1.5 Overview of Book – Text Alternative
Return to parent-slide containing images.
Chapter 1 covers establishing credibility.
Chapters 2 through 4 cover principles of interpersonal
communication.
Chapters 5 through 16 cover principles for and types of business
messages.
Return to parent-slide containing images.
© McGraw Hill
image3.jpeg
image4.png
image5.png
image6.png
image7.png
image8.jpg
image2.png
image1.png
· Draft a 6-page report on outcome measures, issues, and
opportunities for the executive leadership team or applicable
stakeholder group. Introduction
Note: Each assessment in this course builds on the work
you completed in the previous assessment. Therefore, you must
complete the assessments in this course in the order in which
they are presented. As a nurse leader, you may be called upon to
submit a detailed report to your executive leadership team and
key stakeholders that describes a quality or safety problem and
its effects on outcomes, fully supported by relevant and credible
data. This assessment provides an opportunity to draft such a
report in which you can call attention to quality and safety
issues and opportunities, effectively support your position, and
lay out a plan for change. This assessment is based on the
executive summary you prepared in the previous assessment.

20. · Preparation Your executive summary captured the attention
and interest of the executive leadership team, who have asked
you to provide them with a detailed report addressing outcome
measures and performance issues or opportunities, including a
strategy for ensuring that all aspects of patient care are
measured.
·
Note: As you revise your writing, check out the
resources listed on the Writing Center's
Writing Supportpage. As you prepare to complete this
assessment, you may want to think about other related issues to
deepen your understanding or broaden your viewpoint. You are
encouraged to consider the questions below and discuss them
with a fellow learner, a work associate, an interested friend, or
a member of your professional community. Note that these
questions are for your own development and exploration and do
not need to be completed or submitted as part of your
assessment.
· How might you engage stakeholders to help develop,
implement, and sustain a vision to actually change and improve
patient outcomes?
· What arguments might be most effective in obtaining
agreement and support?
· What recommendations would you make to implement a
proposed plan for change?
· The following resources are required to complete the
assessment.
·
APA Style Paper Tutorial [DOCX]. Use this for your
report.
· Requirements
Note: The requirements outlined below correspond to
the grading criteria in the Outcome Measures, Issues, and

21. Opportunities Scoring Guide. Be sure that your written analysis
addresses each point, at a minimum. You may also want to read
the Outcome Measures, Issues, and Opportunities Scoring Guide
and
Guiding Questions: Outcome Measures, Issues, and
Opportunities [DOCX] to better understand how each criterion
will be assessed. Drafting the Report
· Analyze organizational functions, processes, and behaviors in
high-performing health care organizations or practice settings.
· Determine how organizational functions, processes, and
behaviors affect outcome measures associated with the systemic
problem identified in your gap analysis.
· Identify the quality and safety outcomes and associated
measures relevant to the performance gap you intend to close.
Create a spreadsheet showing the outcome measures.
· Identify performance issues or opportunities associated with
particular organizational functions, processes, and behaviors
and the quality and safety outcomes they affect.
· Outline a strategy, using a selected change model, for ensuring
that all aspects of patient care are measured and that knowledge
is shared with the staff.
· Writing and Supporting Evidence
· Write coherently and with purpose, for a specific audience,
using correct grammar and mechanics.
· Integrate relevant and credible sources of evidence to support
assertions, correctly formatting citations and references using
APA style.
· Additional Requirements Format your document using APA
style.
· Use the
APA Style Paper Tutorial [DOCX]. Be sure to include:
· A title page and reference page. An abstract is not required.
· A running head on all pages.
· Appropriate section headings.

22. · Properly-formatted citations and references.
· Your report should be 6 pages in length,
not including the title page and reference page.
· Add your Quality and Safety Outcomes spreadsheet to your
report as an addendum.
·
Portfolio Prompt: You may choose to save your report
to your
ePortfolio.
·
· RUBRIC Competencies Measured By successfully completing
this assessment, you will demonstrate your proficiency in the
following course competencies and assessment criteria:
· Competency 1: Analyze quality and safety outcomes from an
administrative and systems perspective.
· Identify typical quality and safety outcomes and their
associated measures.
· Competency 3: Determine how specific organizational
functions, policies, processes, procedures, norms, and behaviors
can be used to build reliability and high-performing
organizations.
· Analyze organizational functions, processes, and behaviors in
high-performing organizations.
· Determine how organizational functions, processes, and
behaviors support and affect outcome measures for an
organization.
· Identify performance issues or opportunities associated with
particular organizational functions, processes, and behaviors
and the quality and safety outcomes they affect.
· Competency 4: Synthesize the various aspects of the nurse
leader's role in developing, promoting, and sustaining a culture
of quality and safety.
· Outline a strategy for ensuring that all aspects of patient care

23. are measured and that knowledge is shared with the staff.
· Competency 5: Communicate effectively with diverse
audiences, in an appropriate form and style, consistent with
applicable organizational, professional, and scholarly standards.
· Write coherently and with purpose, for a specific audience,
using correct grammar and mechanics.
· Integrate relevant and credible sources of evidence to support
assertions, correctly formatting citations and references using
APA style.
·
Running head: OUTCOMES, ISSUES, AND OPPORTUNITIES
1
Outcomes Measures, Issues, and Opportunities
Kathryn Forsyth
Capella University
HealthCare Quality Safety Management
Outcome Measures, Issues, and Opportunities
July, 2020
Proprietary
2
Outcome Measures, Issues, and Opportunities

24. Medication administration is a large part of care provided to
patients during each shift.
Nurses must deal with multitasking, interruptions, chaotic
environments, and maintain
professional quality care. The United States has between 7,000
and 9,000 medication error
related deaths each year (Tarig, Vashisht, & Scherback, 2020).
Near misses and adverse events
can occur during any point during the medication process from
orders, documenting,
transcribing, dispensing, administering, and/or monitoring
(Tarig, 2020). Nurses have high
patient loads, increased responsibilities, need to be aware of
health costs and ways to decrease
those costs. This report will address measurable patient
outcomes, gaps that need to be addressed
and interventions that are available to improve patient safety.
The Agency for Healthcare Research and Quality (AHRQ) has
defined patient safety as
“freedom from accidental or preventable injuries produced by
medical error” (Agency for
Healthcare Research and Quality (AHRQ), N.D.). A Quality
Interagency Coordination Task
Force was created by the Department of Health and Human

25. Services and other federal agencies
has advised using teamwork is an important way to improve
patient safety (Buljac-Samardzic,
Dekker-van Doorn, & Maynard, 2018). This interagency team
provided an increased awareness
to the media which put a spotlight on an issue that many would
have rather ignored. The group
has pushed to increase reporting of all adverse medical events
(ADEs). By exposing the issues,
the agency has forced facilities to create new policies and
procedures to reduce adverse events.
High-Performing Organizations
Doctors Hospital is a high performing facility with many awards
for providing the best
care. This organization has a culture to encourage the staff
communicate when they have an
opinion on a way to improve patient care. The administration
and leaders use the Triple Aim
Proprietary
3
Framework to evaluate the root cause of medication errors
within the facility. The goal of Triple

26. Aim is to provide interventions to improve quality of
healthcare. The interventions and goals are
used to improve patient outcomes, patient satisfaction, decrease
errors, and reduce cost of
healthcare (American Hospital Association, 2015).
Initiatives focusing on patient-centered quality provides an
analysis of the issues and how
to become a High Reliability organization and implement the
Triple Aim framework. Both high
reliability and Triple Aim focuses on quality improvement
initiatives to reduce and/or prevent
patient injury and improve safety. When using High Reliability
and Triple Aim framework, the
facility is seeing quality interventions with improved patient
outcomes, patient satisfaction, a
decline mortality rates, adverse events, and near misses
(Bodenheimer & Sinsky, 2014). The use
of technology, specifically bar code scanning has decreased
medication errors however the use of
technology should never replace nurses knowledge, competency,
continued use of double
checking information for high risk medications and using the
computer as the third check to
completed the triple check system. By encouraging a

27. questioning attitude, the facility is
encouraging nurse to seek additional information on unfamiliar
drugs and asking questions for
when the medication orders does not make sense for the
patient’s diagnosis (Rodziewicz &
Hipskind, 2020). The implementation of the above initiatives
has reduced the medication errors,
improved communication, and increased patient education on
medications.
Doctors Hospital is working to address medication errors after
each event is report.
Trying to address adverse events and near misses as a systemic
approach is very difficult as there
are many different units in the facility and each unit high risk
medications are not the same.
Nursing leaders encouraging self-reporting of adverse events or
near misses has improved
communication between administration, leaders, and other staff.
The use of non-punitive or
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retribution when reporting medication errors or concerns has
built trust between all parties.

28. Leadership using medication errors as a learning opportunity
instead of placing blame, will
increase the overall quality of care. Determining the root cause
of the medication error to create
interventions to prevent the same error in the future is critical.
Doctors Hospital received a grade
of “c” in 2017, in 2018 the grade was a “d”, and in 2019 the
grade was a “b”. Per the Leapfrog
Group 2020 website, the issues with medication and patient
safety are related to communication
about medications, discharge planning, and staff
communication. Leapfrog automatically gives
the facility a 100 is they are using the barcode system, which is
not indicative of adverse events
and near misses since this is int addressed. In 2018, the hospital
developed initiatives, objectives,
and goals to improve their rating. The new score is now a “b” in
2020 which is attributed to
improved training, improved technology, encouraging
expressing concerns and adverse events,
and creating multidisciplinary group to improve communication.
Outcomes Measured
Doctors hospital mission and vision include a commitment to

29. the care and improvement
of human life. To strive to deliver high quality, cost effective
healthcare by incorporating the
following value statements, to recognize the unique and
intrinsic worth of each individual, to
treat everyone with compassion and kindness, act with absolute
honesty, integrity and fairness in
our business and personal lives. Also, our colleagues are
valuable members of our healthcare
team and vow to treat each other with loyalty, respect, and
dignity (Doctors Hospital, 2020).
Leadership skills, communication, and trust is an integral part
of change, the leader must
be able to lead, deal with conflict, inspire, and communicate
effectively. The interventions,
objectives and goals must be clearly stated and defined for the
staff so there is no
misunderstanding. Outcomes and culture are positively
connected to leadership atmosphere and
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staff satisfaction with their jobs. Experienced staff that have
been with the same facility for many

30. years has experienced changes in policies and procedures, shifts
in vision and mission
statements, working through nursing shortages and improvement
of quality measures. The lack
of leadership will lead to increase in stress in the work
environment, increases the rate of failures
for new interventions, policies, procedures, and outcomes.
Highly motivated leadership can
improve the work environment, increase adherence to new
policies, procedures and intervention
therefore encouraging the staff to meet objectives and goals of
the project.
Adding technology to include bar scanning, smart pumps,
ability to research medication
at bedside to provide education and addressing look alike,
sound alike drugs have decreased
adverse events and near misses. By adding technology, the
facility has enabled the nurses to
provide a third check to use of medication which increases
patient safety and quality of care. By
using High Reliability, we can focus on key elements to include
providing better education to
staff, increase training for leadership, encourage a culture
focused on safety and reduction of

31. medical errors (Chassin & Loeb, 2013).
Performance Issues and Opportunities
Medication errors are extremely costly for the organization and
insurance carriers.
Almost 400,000 a year hospitalized patient has experienced
preventable harm of some type. This
has resulted in approximately 100,000 deaths each year. This
creates an extreme financial burden
that can cost up to $20 billion dollars. Errors may contribute to
the death of a patient or cause
long term harm which can lead legal issues that will increase
costs to the facility (Rodziewicz &
Hipskind, 2020).
Many errors are related to look alike, sound alike drugs, which
is being dealt with by
each facility as well as drug companies. Facilities are
encouraging staff to report these types of
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medications so the facility can come up with a plan to address
the drugs and ways to differentiate

32. between them. One suggestion for drug manufactures is to use
Tall Man lettering and color-
coding which aims to highlight the difference between two
similar drugs by capitalizing part of
the drug names. Many organizations have endorsed Tall Man
lettering including the Joint
Commission and the Institute for Safe Medication Practices
(ISMP) (Larmené-Beld, Alting, &
Taxis, 2018). By encouraging voluntary reporting in a
blameless, guiltless environment will lead
the facility to be able to investigate and determine the core
issue and develop ways to prevent the
error in the future (Patient Safety Network, 2019).
After researching 2019 medication errors, the evidence shows
there is an overwhelming
incorrect usage of the bar code scanning, only 30% of staff was
using the system correctly.
Personally, I have scanned the bar code from the chart which
led to making a medication error by
scanning the wrong bar code and giving the medication to the
wrong patient. There are many
ways to override the system when alerts pop up, many nurses do
not even read the alerts. One
way to address this is update the bar code system for the nurse

33. to have to manually type a reason
why the alert is being overridden. This will impact time but will
overall make the nurse more
accountable. Total numbers of errors on the 50 bed burn unit for
2019 was 6000. Total resulting
in injury was 600 and total deaths 15. In 2019, the average
number of medical errors on the 50-
bed unit was sixteen per day, this seems high, however
medication errors include the route,
dosage, time, patient, and medication. So many of these errors
could be related to time and most
errors did not cause injury or death. The attached spreadsheet
breaks down the errors in 2019 and
2020 by total errors per year, total errors resulting in injury,
total errors resulting in death, and
correct use of bar code scanning.
Strategy Outline
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Nursing leadership plays a key role in implementation of
change, encouraging quality
communication, and improving patient outcomes. Lack of strong

34. leaders will ultimately lead to
failure of the initiative, objectives, and goals of the project.
Barriers may inadvertently be placed
by administration, leadership, and other staff which may limit
the nurse being able to provide
quality, cost efficient, safe care. Forces that can drive change in
healthcare include cost, need of
specific treatments, high patient to staff ratios, ethics, values,
code of conduct, and the drive to
improve patient outcomes and satisfaction (Salmond &
Echevarria 2017). Use of change theory
for this report is useful as without a structured approach the
initiatives and goals will fail.
Change theory includes Mr. Lewin’s use of unfreezing, moving,
and refreezing. Unfreezing is to
identify the issues and assess need for change. Moving is the
interventions needed for a plan to
be created and put into effect. Refreezing the plan is in place,
the changes have been made and a
new normal is established (Cummings, Bridgman, & Brown,
2016).
Leading change is a challenge for leaders with the intricacies
and challenges of ever-
changing health care environments to ensure quality patient

35. care. Rogers’ Innovation Diffusion
Theory includes five stages include knowledge, persuasion,
decision, implementation, and
confirmation (Udod & Wagner, 2018). Leaders using the change
theory and the five steps of
Rogers’ theory will be able to ignite change, address strengths
and weaknesses of the team,
encourage the team to incorporate interventions to achieve the
goals. Leaders need to be able to
adapt and use multiple types of leadership theories, have
excellent listening skills, and create a
welcoming environment to encourage open, honest
communication, and defuse conflict.
For this project I believe I would use Rogers’ Innovation
Diffusion Theory, the first stage
is knowledge, implementing new education on technology, the
need for the change, and the
initiatives, objectives and goals would be reviewed. This would
encourage everyone to be ready
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for the change. The leaders would want to address the strengths
and weakness of the staff, by

36. determining the staff that area already using the bar code
system correctly so they can pair up
others who are not for mentoring. The idea would be to use the
strength of some to overcome the
weakness of others with mentoring, peer reviews, and
encouragement, this would be part of the
persuasion step. The third step is the decision, which is when
the interventions are decided upon,
when the project will start. Fourth step is to implement the
interventions and lastly would be to
confirm the interventions are moving the staff towards the goals
set.
By implementing additional teaching on use of bar scanning
system, updating the
technology to force the nurse to address the reason when the
system alerts, adding triple checks
to high risk medications, encouraging nurses use Wi-Fi to
address any medication they need
education on and provide that education to the patient and
reporting of look alike, sound alike
drugs so the pharmacist can tag those drugs with an additional
alert. By implementing these
initiatives, the 2020 data shows a 50% reduction in medication
errors, errors resulting in injury

37. are down 66%, injury resulting in death is down 66% and
correct use of bar code scanning has
improved by 60%. Please see attached spreadsheet to review the
past six months and see how the
initiatives implemented has reduced errors per month.
Proposed plans will be shared with all stakeholders either in a
staff meeting or
electronically. During the group presentation, the need for
change will be addressed,
interventions, objectives, and goals will be shared. Everyone
present will be given an opportunity
to review the written material, ask questions and express
concerns or ideas.
Conclusion
Medication errors have always been an area we can all improve
on, use of technology
with bar code scanning, smart pumps, and the ability to research
drug information at the bedside
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has reduced errors. Healthcare is an ever-changing environment;
we must learn to change and

38. initiate policies and procedure to improve patient safety.
Striving to reduce near misses and
adverse events will be a goal for every facility. We must work
together to improve safety and
patient outcomes by being more diligent when administering
medications.
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References
Agency for Healthcare Research and Quality. (n.d.a). Patient
safety.
https://psnet.ahrq.gov/glossary?glossary%5B0%5D=term%3AP
American Hospital Association. (2015). Care and payment
models to achieve the Triple Aim.
Retrieved from https://www.aha.org/ahahret-guides/2016-01-26-
care-and-payment-
models-achieve-triple-aim-
0#:~:text=Hospitals%20and%20health%20care
%20systems,designing%20new%20care%20delivery%20systems
.
Bodenheimer, T and Sinsky, C. (2014). From Triple to
Quadruple Aim: Care of the Patient

39. Requires Care of the Provider. The Annals of Family Medicine,
12 (6) 573-576; DOI:
https://doi.org/10.1370/afm.1713
Buljac-Samardzic, M., Dekker-van Doorn, C., & Maynard, M.
T. (2018). Teamwork and
teamwork training in health care: An integration and a path
forward. Group &
Organization Management, 43(3), 351-356.
doi:10.1177/1059601118774669
Chassin, M., & Loeb, J. (2013). High-reliability health care:
getting there from here. The
Milbank quarterly, 91(3), 459–490.
https://doi.org/10.1111/1468-0009.12023
Cummings, S., Bridgman, T., & Brown, K. G. (2016).
Unfreezing change as three steps:
Rethinking Kurt Lewin’s legacy for change management.
Human relations, 69(1), 33-60.
Doctors Hospital. (2020). Mission and Vision. Retrieved from
https://doctors-
hospital.net/about/mission-and-vision.dot
The Leapfrog Group. (2020). Hospital Safety Grade. Retrieved
from
https://www.hospitalsafetygrade.org/h/doctors-hospital-of-

40. augusta?
findBy=hospital&hospital=Doctors+Hospital+of+Augusta&rPos
=237&rSort=grade
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11
Larmené-Beld, K.H.M., Alting, E.K. & Taxis, K. (2018). A
systematic literature review on
strategies to avoid look-alike errors of labels. Eur J Clin
Pharmacol 74, 985–993.
https://doi.org/10.1007/s00228-018-2471-z
Patient Safety Network (PSA). (2019). Medication Errors and
Adverse Drug Events. Retrieved
from https://psnet.ahrq.gov/primer/medication-errors-and-
adverse-drug-events
Rodziewicz L., Hipskind J. (2020). Medical Error Prevention.
Retrieved from
https://www.ncbi.nlm.nih.gov/books/NBK499956/
Salmond, S. W., & Echevarria, M. (2017). Healthcare
Transformation and Changing Roles for
Nursing. Orthopedic nursing, 36(1), 12–25.
https://doi.org/10.1097/NOR.0000000000000308

41. Tariq, A., Vashisht, R., Scherbak, Y. (2020). Medication Errors.
StatPearls Publishing. Retrieved
from: https://www.ncbi.nlm.nih.gov/books/NBK519065/
Udod, S., & Wagner, J. (2018). Common Change Theories and
Application to Different Nursing
Situations. Leadership and Influencing Change in Nursing.
Upadhyay, S. (2020). Keeping patients safe: How has the
patient safety movement evolved in the
U.S.? Patient Safety & Quality Healthcare. Retrieved from
https://www.psqh.com/analysis/keeping-patients-safe-how-has-
the-patient-safety-
movement-evolved-in-the-u-s/
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