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Patient safety and quality improvementefforts have grown impressivelyin recent years. Despite thesegains, though, questions remain about thevalue of improving quality from both societaland hospital perspectives. From the societalperspective, the question is whether gainsfrom improving quality reduce costs to patients,hospitals, and payers or, if they increasecosts, whether the value of the qualityimprovement to patients justifies spendingmore on care. From the hospital perspective,the question is whether cost savings or revenuegains from improving quality offset thecosts of quality initiatives—that is, whetherthere is a business case for quality. SheilaLeatherman and colleagues, in language relevantto both perspectives, recently wrote,“There is a compelling need to understandbetter the economic implications for allstakeholders of implementing quality improvement.”1The growing body of evidence linking hospitalworkforces to patient outcomes suggeststhat one way to improve quality is to increasenurse staffing.2 Because nurses are a large portionof hospital labor costs, the cost of increasingstaffing would not be insignificant. Theadditional costs of having more nurses, however,should be offset to some extent by the
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