Productivity: a context for excellence

Inductively created measures of the sort described above enable the ambulatory care manager to make a crucial decision: Are the outcomes worth the cost involved? As Collins (1988, p. 235) notes, "Our nursing product is quality care based on principles and standards of practice... and substantiated and enhanced through quantifying our practice." By using nursing resources wisely, we can "moderate the march on the market...for caring and access of what we are here for" (Cunningham, 1983, p. 90). In relaying her feelings during treatment for a malignant breast tumor, Kaufman (1989) supports the contention that caring and access are essential parts of a therapeutic regime. Curtin (1987, p. 7) warns that "You cannot provide health care by taking the care out of it." This project allowed nurses to create their own measurement system that identified and quantified the professional nursing tasks involved in each workload indicator. Nonprofessional activities were also identified, quantified, and delegated to appropriate levels of staff, thus increasing the control of the nurses over their own practice environment. In the words of Curtin (1987, p. 7), "Losers count time to make heads roll. Winners use their heads to make time count. This country cannot afford to place its health in the hands of losers."