Restructuring the US Health Care Delivery System


Like any other healthcare system of the world, the US medical system has undergone and continues to undergo a series of changes. The changes that target health care delivery are related to the advancement of the methods of care, resource use, and the organization of professional role performance for better patient outcomes in the long-term perspective. In particular, one of the current regulations is the Patient Safety and Quality Improvement Act which was introduced in 2005 and remained one of the most important regulations for monitoring medical errors. Due to the growing number of cases of patient harm and medical costs induced by medical error, the legislation aims to change the health care delivery system by ensuring its continuous improvement. This paper seeks to explore the law by identifying the effects of patient safety and quality improvement measures through launching patient safety organizations, databases, and confidentiality reassurance. The regulation will be examined from the perspectives of its impact on the nursing role, quality measures, patient outcomes, leadership, and management, as well as the emerging trends in the sphere of patient safety.

Patient Safety and Quality Improvement Act of 2005

Current laws applicable to the US health care delivery system have been enacted within the past several decades and continue being followed to provide continuous striving for performance excellence. The Patient Safety and Quality Improvement Act was introduced to the United States’ health care system legislation in 2005 and established a framework for the consistent and deliberate reduction of medical errors (Gandhi et al., 2018). In particular, this regulation addresses several directions of health care delivery, including patient safety organizations, professional conduct improvement, and patient data confidentiality assurance.

The initiation of patient safety organizations aims to facilitate the exchange of data between different stakeholders within the health care system for a more transparent medical performance. According to Bates and Singh (2018), such “organizations bring groups together to improve wider learning by sharing data from voluntary reporting under privacy and confidentiality protection” (p. 1738). They are formed based on hospitals or a chain of providers that exchange information on possible errors for further examination and prevention. Moreover, such organizations engage in practices to minimize harm to patients through educational and promotional efforts (Bates and Singh, 2018). Through such efforts induced by the Act, the health care system could advance transparency in all fields of practice, including nursing. As a result, the implementation of the law showed “compelling evidence that sharing data, successes, and failures can markedly accelerate learning and improvement” (Gandhi et al., 2018, p. 1024). Moreover, the law conceptualizes the Patient Safety Work Product, which implies all the health-related data collected, stored, and processed by medical stakeholders; this product’s confidentiality and safety are guaranteed under the law provisions.

The outlined characteristics of the Patient Safety and Quality Improvement Act demonstrate the importance of the execution of high professional performance standards by physicians and nurses. In particular, the law shapes the nursing practice to necessitate nurses’ accuracy and transparency in conducting diagnosing and treatment procedures (Gandhi et al., 2018). Moreover, nurses’ role as educators for patients and car quality advocates is shaped by this legislation. Under the provisions of the Patient Safety and Quality Improvement Act, nurses are expected to engage in patient safety activities to minimize harm and medical errors at all levels of care delivery. In addition, nursing responsibilities are expanded to the reassurance of patient confidentiality prioritization and learning of the health care community based on successes and failures for continuous education and patient care improvement.

Quality Measures and Pay for Performance Effect on Patient Outcomes

When considering the quality of measures and pay for performance in the context of the explored legislation, one might emphasize that the overall bill is directed at improving long-term and far-reaching patient outcomes. Indeed, the quality of providers’ performance is measured by minimizing medical errors that impose additional costs for the health care system (Gandhi et al., 2018). The voluntary reporting of incidents and errors by nurses and other medical stakeholders implies their long-term contribution to the learning of the overall health care community to implement best practices. The law does not explicitly address the pay-for-performance issue due to the voluntary nature of the reporting to the patient safety organizations. However, the responsibilities of nurses and other stakeholders to engage in continuous learning based on the reports and the prioritization of patient confidentiality primarily benefit patient outcomes. These performance guidelines reduce additional health care costs and eliminate harm and risks for patients served by nurses in US health care facilities.

Professional Nursing Leadership and Management Roles

In the context of the high level of medical errors and their negative effect on health care costs, the implementation of the provisions of the Patient Safety and Quality Improvement Act is essential. Since its introduction, the roles of management and leadership of professional nursing have changed significantly and continue to be transformed. Indeed, nursing leaders are expected to deliver care in a manner that prioritizes patient safety and confidentiality with the encouraged reporting of the failures of near misses to the appropriate organizations (Bates & Singh, 2018). Nursing managers’ roles transform from mere administration and care delivery to the promotion of continuous learning of nurses as well as patient education. The advancement of evidence-based care and the prioritization of patient safety through the minimization of medical errors become an inevitable element of nursing leadership under the Patient Safety and Quality Improvement Act.

Emerging Trends

Among the emerging trends in the health care delivery system related to patient safety and quality improvement, the issue of using technologically advanced techniques is essential. According to Classen et al. (2018), regardless of the implementation of quality improvement and error elimination measures under the provisions of the law, the number of medical errors remains high. One of the possible and potentially beneficial ways of advancing patient safety through care quality is digital technologies. This trending issue implies that the “broad adoption of electronic health records (EHRs) offers a significant opportunity to leverage digital information to improve safety measurement and management using real-time data” (Classen et al., 2018, p. 1805). The second way of eliminating medical errors will be based on the advanced virtual-reality education of health care professionals using the data on past failures or malpractice examples (Gandhi et al., 2018). Thus, within the next five years, it is expected that new approaches to resolving the problem of medical errors will be implemented, namely the adoption of electronic databases and virtual learning.


In summation, the current health care system of the United States of America continues to change and develop, which is evident through the implementation of federal regulations. The Patient Safety and Quality Improvement Act has been one of the pivotal and recurring regulations in the medical system that has allowed for significant advancement in the infrastructure, skills, professional knowledge, and guidelines for better patient outcomes. In particular, this regulation has been impactful for developing patient safety organizations’ networks, advancing patient confidentiality, and continuous staff learning. Since medical error elimination is an emerging trend in health care, it is expected to be addressed by the advancement of digital technology use and virtual learning for better patient outcomes.


Bates, D. W., & Singh, H. (2018). Two decades since to err is human: An assessment of progress and emerging priorities in patient safety. Health Affairs, 37(11), 1736-1743.

Classen, D., Li, M., Miller, S., & Ladner, D. (2018). An electronic health record-based real-time analytics program for patient safety surveillance and improvement. Health Affairs, 37(11), 1805-1812.

Gandhi, T. K., Kaplan, G. S., Leape, L., Berwick, D. M., Edgman-Levitan, S., Edmondson, A., Meyer, G. S., Michaels, D., Morath, J. M., Vincent, C., & Wachter, R. (2018). Transforming concepts in patient safety: A progress report. BMJ Quality & Safety, 27(12), 1019-1026.

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