title: Improving the safety and quality of nursing care through standardized operating procedures in Bosnia and Herzegovina.
abstract: OBJECTIVE
  We explored how selected 'positive deviant' healthcare facilities in Bosnia and Herzegovina approach the continuous development, adaptation, implementation, monitoring and evaluation of nursing-related standard operating procedures.
  
  
  BACKGROUND
  Standardized nursing care is internationally recognized as a critical element of safe, high-quality health care; yet very little research has examined one of its key instruments: nursing-related standard operating procedures.
  
  
  BACKGROUND
  Despite variability in Bosnia and Herzegovina's healthcare and nursing care quality, we assumed that some healthcare facilities would have developed effective strategies to elevate nursing quality and safety through the use of standard operating procedures.
  
  
  METHODS
  Guided by the 'positive deviance' approach, we used a multiple-case study design to examine a criterion sample of four facilities (two primary healthcare centres and two hospitals), collecting data via focus groups and individual interviews.
  
  
  RESULTS
  In each studied facility, certification/accreditation processes were crucial to the initiation of continuous development, adaptation, implementation, monitoring and evaluation of nursing-related SOPs. In one hospital and one primary healthcare centre, nurses working in advanced roles (i.e. quality coordinators) were responsible for developing and implementing nursing-related standard operating procedures. Across the four studied institutions, we identified a consistent approach to standard operating procedures-related processes.
  
  
  CONCLUSIONS
  The certification/accreditation process is enabling necessary changes in institutions' organizational cultures, empowering nurses to take on advanced roles in improving the safety and quality of nursing care.
  
  
  CONCLUSIONS
  Standardizing nursing procedures is key to improve the safety and quality of nursing care. Nursing and Health Policy are needed in Bosnia and Herzegovina to establish a functioning institutional framework, including regulatory bodies, educational systems for developing nurses' capacities or the inclusion of nursing-related standard operating procedures in certification/accreditation standards.
authors.affiliation: College for Health-Care Professionals Claudiana, Bozen, Italy.|Institute of Nursing Science, University of Basel, Basel, Switzerland.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Ausserhofer
authors.affiliation: Health Management Centre, Public Health Institute of Republic of Srpska, Banjaluka, Bosnia and Herzegovina.
authors.forename: Severin
authors.initials: S
authors.lastname: Rakic
authors.affiliation: Agency for Healthcare Quality and Accreditation in Federation of Bosnia and Herzegovina (AKAZ), Sarajevo, Bosnia and Herzegovina.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Novo
authors.affiliation: Fondacija fami, Sarajevo, Bosnia and Herzegovina.
authors.forename: Emira
authors.initials: E
authors.lastname: Dropic
authors.affiliation: Fondacija fami, Sarajevo, Bosnia and Herzegovina.
authors.forename: Eldin
authors.initials: E
authors.lastname: Fisekovic
authors.affiliation: Fondacija fami, Sarajevo, Bosnia and Herzegovina.
authors.forename: Ana
authors.initials: A
authors.lastname: Sredic
authors.affiliation: Institute of Nursing Science, University of Basel, Basel, Switzerland.
authors.forename: Greet
authors.initials: G
authors.lastname: Van Malderen
mesh_terms: D000068:Accreditation; D017522:Bosnia and Herzegovina; D003695:Delivery of Health Care; D006291:Health Policy; D006801:Humans; D009732:Nursing Care / Q000592:standards*; D011787:Quality of Health Care
keywords: Bosnia and Herzegovina; Hospitals; Nursing; Nursing Process; Nursing Services; Primary Health Care; Qualitative Research; Quality of Health Care; Safety; Standard of Care