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Quality Improvement Initiative Proposal

 Quality Improvement Initiative Proposal

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Prepare an 8–10-page data analysis and quality improvement initiative proposal based on a health issue of professional interest to you. The audience for your analysis and proposal is the nursing staff and the interprofessional team who will implement the initiative.

“A basic principle of quality measurement is: If you can’t measure it, you can’t improve it” (Agency for Healthcare Research and Quality, 2013).

Health care providers are on an endless quest to improve both care quality and patient safety. This unwavering commitment requires hospitals and care givers to increase their attention and adherence to treatment protocols to improve patient outcomes. Health informatics, along with new and improved technologies and procedures, are at the core of virtually all quality improvement initiatives. The data gathered by providers, along with process improvement models and recognized quality benchmarks, are all part of a collaborative, continuing effort. As such, it is essential that professional nurses are able to correctly interpret, and effectively communicate information revealed on dashboards that display critical care metrics.

Questions to Consider

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.

Reflect on QI initiatives focused on measuring and improving patient outcomes with which you are familiar.

  • How important is the role of nurses in QI initiatives?
  • What quality improvement initiatives have made the biggest difference? Why?
  • When a QI initiative does not succeed as planned, what steps are taken to improve or revise the effort?

Assessment Instructions

PREPARATION

In this assessment, you will propose a quality improvement (QI) initiative proposal based on a health issue of professional interest to you. The QI initiative proposal will be based on an analysis of dashboard metrics from a health care facility. You have one of two options:

Option 1

If you have access to dashboard metrics related to a QI initiative proposal of interest to you:

  • Analyze data from the health care facility to identify a health care issue or area of concern. You will need access to reports and data related to care quality and patient safety. If you work in hospital setting, contact the quality management department to obtain the data you need.
  • You will need to identify basic information about the health care setting, size, and specific type of care delivery related to the topic that you identify. You are expected to abide by HIPAA compliance standards.
Option 2

If you do not have access to a dashboard or metrics related to a QI initiative proposal:

  • You may use the hospital data set provided in the media piece titled Vila Health: Data Analysis. You will analyze the data to identify a health care issue or area of concern.
  • You will follow the same instructions and provide the same deliverables as your peers who select Option 1.

INSTRUCTIONS

Analyze dashboard metrics related to the selected issue.

  • Provide the selected data set in the proposal.
    • Assess the stability of processes or outcomes.
    • Delineate any problematic variations or performance failures.
  • Evaluate QI initiatives on the selected health issue with existing quality indicators from other facilities, government agencies, and non-governmental bodies on quality improvement.
    • Analyze challenges that meeting prescribed benchmarks can pose for a heath care organization and the interprofessional team.
  • Outline a QI initiative proposal based on the selected health issue and data analysis.
    • Identify target areas for improvement.
    • Define what processes can be modified to improve outcomes.
    • Propose strategies to improve quality.
    • Define interprofessional roles and responsibilities as they relate to the QI initiative.
    • Provide recommendations for effective communication strategies for the interprofessional team to ensure the success of the QI initiative. Briefly reflect on the impact of the proposed initiative on work-life quality of the nursing staff and interprofessional team.
  • Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.

Note: Remember, you can submit all, or a portion of, your draft to Smarthinking for feedback, before you submit the final version of your analysis for this assessment. However, be mindful of the turnaround time for receiving feedback, if you plan on using this free service.

The numbered points below correspond to grading criteria in the scoring guide. The bullets below each grading criterion further delineate tasks to fulfill the assessment requirements. Be sure that your Quality Improvement Initiative Evaluation addresses all of the content below. You may also want to read the scoring guide to better understand the performance levels that relate to each grading criterion.

  1. Analyze data to identify a health care issue or area of concern.
    • Identify the type of data you are analyzing (from your institution or from the media piece).
    • Discuss why the data matters, what it is telling you, and what is missing.
    • Analyze dashboard metrics and provide the data set in the proposal.
    • Present dashboard metrics related to the selected issue.
    • Delineate any problematic variations or performance failures.
    • Assess the stability of processes or outcomes.
    • Evaluate the quality of the data and what can be learned from it.
    • Identify trends, outcome measures and information needed to calculate specific rates.
    • Analyze what metrics indicate opportunities for quality improvement.
  2. Outline a QI initiative proposal based on a selected health issue and supporting data analysis.
    • Identify benchmarks aligned to existing QI initiatives set by local, state, or federal health care policies or laws.
    • Identify existing QI initiatives related to the selected issue, and explain why they are insufficient.
    • Identify target areas for improvement, and define what processes can be modified to improve outcomes.MSN-FP6016 Capella Data Analysis & Quality Improvement Initiative Proposal
    • Propose evidence-based strategies to improve quality.MSN-FP6016 Capella Data Analysis & Quality Improvement Initiative Proposal
    • Evaluate QI initiatives on the selected health issue with existing quality indicators from other facilities, government agencies, and non-governmental bodies on quality improvement.
    • Analyze challenges that meeting prescribed benchmarks can pose for a heath care organization and the interprofessional team.MSN-FP6016 Capella Data Analysis & Quality Improvement Initiative Proposal
  3. Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work-life quality.
    • Define interprofessional roles and responsibilities as they relate to the data and the QI initiative.
    • Explain how you would you make sure that all relevant roles are fully engaged in this effort.
    • Explain what non-nursing concepts would you incorporate into the initiative?
    • Identify how outcomes to measure the effect of the intervention affect the interprofessional team.
    • Briefly reflect on the impact of the proposed initiative on work-life quality of the nursing staff and interprofessional team. Describe how work-life quality is improved or enriched by the initiative.
  4. Apply effective communication strategies to promote quality improvement of interprofessional care.
    • Identify the kind of interprofessional communication strategies that will be effective to promote and ensure the success of this performance improvement plan or quality improvement initiative.
    • In addition to writing, identify communication models (like CUS, SBAR) that you would include in your initiative proposal.
  5. Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
  6. Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.

SUBMISSION REQUIREMENTS

  • Length of submission: 8–10 double-spaced, typed pages, not including title and reference page.
  • Number of references: Cite a minimum of five sources (no older than seven years, unless seminal work) of scholarly, peer-reviewed, or professional evidence that support your evaluation, recommendations, and plans

 

cf_exemplar_msn_fp6016_assessment_3.pdf

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Running head: QUALITY IMPROVEMENT INITIATIVE PROPOSAL 1 Data Analysis and Quality Improvement Initiative Proposal Learner’s Name Capella University Quality Improvement for Interprofessional Care Data Analysis and Quality Improvement Initiative Proposal July, 2017 Copyright ©2017 Capella University. Copy and distribution of this document are prohibited. Comment [JS1]: Good job with the submission. It follows the rubric. For the most part is written in scholarly voice. The submission is clear and concise. References and citations are used to support your opinion and position with relevant evidence. Please see my tracked changes for areas of revision. QUALITY IMPROVEMENT INITIATIVE PROPOSAL 2 Data Analysis and Quality Improvement Initiative Proposal I. Introduction Health care professionals are constantly striving to improve the quality of care and safety provided to their patients. The culture of care quality and patient safety depends on a strong and supportive work environment that promotes leadership, evidence-based practice, effective communication, and interprofessionalism. Nurse leaders play a crucial role in establishing this culture and directly influence quality outcomes across an organization. II. Problems and Needs The role of nurse leaders in maintaining the quality in the nursing and clinical departments is discussed using the example of TrueWill General Hospital (TGH), a multispecialty hospital in the United States. Recently, the hospital’s quality management office, as part of its annual assessment of organizational quality, completed its analysis of dashboard metrics for the surgical units for the year 2015–2016. The office released the data in its Quality and Safety Report 2015–2016. The surgical units’ data included adverse events and near misses and used four quality indicators: length of stay (LOS) exceeding 7 days, patient readmission rates, pain level between 7 and 10 for more than 24 hours, and patients with pressure ulcers. III. Proposed Solution The results of the analysis showed that three quality indicators—pain levels, readmission rates, and pressure ulcers—performed below the hospital’s benchmarks (see Table 1 and Appendix for data and descriptions of indicators and benchmarks). The connection between these indicators and the services of the surgical units’ nurses will be discussed in this proposal for a quality improvement initiative. The proposal will analyze the relational patterns between the Copyright ©2017 Capella University.MSN-FP6016 Capella Data Analysis & Quality Improvement Initiative Proposal
MSN-FP6016 Capella Data Analysis & Quality Improvement Initiative Proposal Copy and distribution of this document are prohibited. QUALITY
IMPROVEMENT INITIATIVE PROPOSAL 3 indicators and the data, identify assumptions governing health care quality and nursing characteristics, determine methods to discover the root causes of quality issues, and recommend a framework as well as strategies to improve quality outcomes in the surgical units. Analysis of Dashboard Metrics to Identify Quality Issues The patients who require round-the-clock perioperative care are admitted to TGH’s surgical units, which are equipped for general, orthopedic, urology, as well as ambulatory surgery. The critical nature of patients admitted to these units’ makes quality and safety the units’ highest goals. Quality and safety outcomes are regularly evaluated in these units. The units are staffed by teams of interdisciplinary professionals—physicians, nurses, therapists, dieticians, pharmacists, and ancillary medical staff. Table 1 Quality and Safety Report 2015–2016 Unit – Year Surgical 2015 Surgical 2016 LOS exceeding 7 days Patient readmission Pain level between 7 and 10 for more than 24 hours Patients with pressure ulcers Total 43 29 15 14 101 31 43 30 25 129 The data available from the Quality and Safety Report in Table 1 revealed that the annual patient readmission rates increased from 29 incidents in 2015 to 43 in 2016. Similarly, the number of patients who experienced pain for more than 24 hours without relief doubled from 15 in 2015 to 30 in 2016. Pressure ulcers, a common quality and safety issue in surgical patients, also increased to 25 from 14 in 2015. Conversely, the units reported a drop in the number of patients whose LOS exceeded 7 days—from 43 in 2015 to 31 in 2016. Copyright ©2017 Capella University. Copy and distribution of this document are prohibited. QUALITY IMPROVEMENT INITIATIVE PROPOSAL 4 The outcomes are a cause for concern because they can affect the hospital’s stakeholders—the patients, health care professionals, and the organization—in various ways. Patient readmissions are a costly outcome for TGH because the Patient Protection and Affordable Care Act, through its Hospitals Readmissions Reductions Program, financially penalizes hospitals with higher than expected readmissions (Bartel, Chan, & Kim, 2014). Hefty penalties are enforced because readmissions are thought to be the result of poor follow-up care (Abelson, 2013).
MSN-FP6016 Capella Data Analysis & Quality Improvement Initiative ProposalFurthermore, studies have found an association between LOS and the risk of readmissions. Bartel et al. (2014) reviewed prior literature on the impact of decreasing patient LOS and increasing readmission rates and came to the conclusion that a patient who stays for an additional day may reach a higher level of stability. At TGH, health care professionals may have faced immense pressure to reduce patient LOS to control per capita health costs. The pressure could have forced the units’ nurses and doctors to rush through patient care plans and hasten the process of educating patients regarding post-discharge behavior. Furthermore, patients who are readmitted may lose trust in the ability of their health care providers to provide complete and quality care. Just as readmissions are a quality issue that affects all stakeholders, high pain levels and pressure ulcers affect the surgical units’ nurses and patients. This inference is based on the theory of nurse-sensitive patient outcomes, which explains that pain and pressure ulcers are patient outcomes that depend on the quantity and quality of nursing (Stalpers, de Brouwer, Kaljouw, & Schuurmans, 2015). Based on this inference, it can be assumed that there could be issues in the performance and quality of nursing in TGH’s surgical units. Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 5 Moreover, there is evidence linking pressure ulcers and postoperative pain to a higher risk of readmissions (Kirkner, 2017; Lyder et al., 2012). While TGH’s data do not directly link pressure ulcers and pain to readmission rates, it is possible to theorize that reducing pressure ulcers and pain in patients will also reduce readmissions. Therefore, the surgical units’ nurses can help prevent readmissions by preventing ulcers and managing pain in patients more efficiently. The standard of nursing quality is an important predictor of favorable quality outcomes. Based on the analysis of the data in the report, TGH’s nurse leaders met with the units’ nurses to decipher the nursing factors that contributed to the unfavorable outcomes. The nurse leaders identified the problem to be the transactional leadership style practiced by the perioperative charge nurses. Transactional leadership is defined as an exchange relationship that clearly denotes the follower from the leader and is focused on the contingent reward system with individuals being rewarded or punished based on their performance (Thomas, 2016). Transactional leadership may have become the dominant style of leadership in TGH’s surgical units because of the lack of training and incompetence among nurses. The nurse leaders decided to change the leadership style of charge nurses with a quality improvement (QI) initiative based on the data analysis. The proposal for the QI initiative will identify an ideal leadership style and propose strategies to implement the style. Knowledge gaps or areas of uncertainty that require further evaluation will also be discussed in the proposal. Outline for the Quality Improvement Initiative Proposal Charge nurses occupy a front-line position in influencing the staff engaged in patient care (Thomas, 2016). They are responsible for functions such as coordinating and evaluating nurse staffing plans, balancing unit budgets, and making patient assignments. However, the transactional leadership at TGH was ineffective because the charge nurses were not skilled Copyright ©2017 Capella University. Copy and distribution of this document are prohibited. Comment [JS2]: This reference is almost too old to be viable for relevant evidence based practice. In health care, it is important to use up to date references that are not more than 5 years old.
I might suggest finding a more recent reference. QUALITY IMPROVEMENT INITIATIVE PROPOSAL 6 enough to notice nurse dissatisfaction, prevent conflicts and competition between the nurses, and establish effective communication channels. The surgical units’ nurses were not given any guidance by the charge nurses on accomplishing quality improvement tasks or participating in collaborative and interprofessional efforts. Because of the transactional leadership’s tendency to reward or punish staff based on performance (Thomas, 2016), the nursing staff paid more attention to accomplishing tasks such as discharging patients quickly than ensuring patient satisfaction. The QI initiative will provide strategies that support the transition from transactional to transformational leadership. Transformational leaders focus on internalizing ethical and professional values in their team members and assist in aligning those values with organizational goals. A transformational leader’s optimism, selfless service, and creativity motivate and encourage teams. It is worth noting that the motivational and inspirational aspects of transformational leadership will significantly change the work environment and the nurses’ commitment to the organization (Thomas, 2016). The quality improvement model that is best suited to introduce and implement transformational leadership is the plan-do-study-act (PDSA) model.
MSN-FP6016 Capella Data Analysis & Quality Improvement Initiative ProposalHence, the model will serve as the framework for the QI initiative. The model is effective when there is a need for accelerated change, as in TGH’s case. The four steps of the framework can affect system change that will promote long-term improvement and implementation of the initiative on a larger scale. Various strategies incorporated into the PDSA steps will be discussed briefly (Thomas, 2016). 1. Plan: This step involves setting up an interdisciplinary team. While the nurse leaders already identified the problem to be transactional leadership through discussions and the analysis, the interprofessional team will validate the previous Copyright ©2017 Capella University. Copy and distribution of this document are prohibited. QUALITY IMPROVEMENT INITIATIVE PROPOSAL 7 results using a Multifactor Leadership Questionnaire survey. The survey will be distributed to the nurses as well as other perioperative health care professionals. After the results of the survey are analyzed, the team will define achievable goals such as establishing a transformational leadership style and improving the affected quality indicators. 2. Do: In this step, the team, with support from the organization, will create a strategic plan to achieve the defined goals.
Examples of strategies include introducing training modules for leadership development and quality and safety education. 3. Study: The results from the implementation of strategies devised in the previous steps are analyzed. Observations are based on different interprofessional perspectives and are set against the performances of TGH’s surgical units, not just nursing. 4. Act: In the final step of the PDSA model, the goals set in step one are reevaluated to determine whether the strategies were effective. TGH can carry out the step by calculating data on the four quality indicators and noting increases or decreases in the quality outcomes. Based on that evaluation, the PDSA cycle is deemed complete or renewed with new goals and strategies. Despite the effectiveness of the PDSA model, knowledge gaps and areas of uncertainty may still affect the QI process. First, the use of just four indicators to measure quality outcomes in the surgical units can give a partial or narrow understanding of the issues. Further evaluation should be done using indicators such as mortality and patient satisfaction and nurse-sensitive indicators such as nurse perception of job and level of nursing education. Copyright ©2017 Capella University. Copy and distribution of this document are prohibited. QUALITY IMPROVEMENT INITIATIVE PROPOSAL 8 Secondly, the data only shows problems affecting the hospital’s surgical units. Foundational theories such as systems theory explain how problems in one part of the organization affect performance and quality outcomes in other parts. However, there is a lack of data on quality issues from other departments at TGH that could be connected to the issues seen in the surgical unit. Therefore, the team spearheading the QI efforts can take steps to include data from other units and departments to create a comprehensive QI initiative. Another area of uncertainty is the studies connecting nursing leadership and patient outcomes. Most studies do not test whether nursing leadership directly improves patient outcomes; they merely analyze the connection conceptually. Understanding the relationship between leaders and patient outcomes requires interventions and longitudinal studies with continuous observations (Wong, 2015).
To achieve better patient outcomes by changing the nursing leadership, the proposed QI initiative will be guided by various interprofessional perspectives. The perspectives will support patient safety, cost-effectiveness, and work–life quality for nurses and other units’ staff. Each perspective will address an aspect relevant to TGH, such as leadership and teamwork. The discussion will also identify assumptions that highlight the importance of these perspectives. Integration of Interprofessional Perspectives That Support Quality Improvement Over the years, efforts to improve health care quality and safety drew inspiration from various interprofessional perspectives. The perspectives important to TGH are leadership theory, systems theory, and collaborative relationships. The identification of these specific perspectives and their integration into the hospital’s QI initiative are based on assumptions made on the factors that influence patient outcomes. One assumption is that health care systems are interconnected and problems in one unit or department can affect other parts of the system (Huber, 2017); problems in the surgical units Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.MSN-FP6016 Capella Data Analysis & Quality Improvement Initiative Proposal
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 9 can affect the quality of other hospital departments. When quality is compromised in multiple departments, the organization will not be able to function properly and achieve its goals of providing quality and safe care for patients. Poor nursing performance and quality also affect the performance of doctors, therapists, pharmacists, dieticians, and other interdisciplinary professionals working in the surgical unit. These health care professionals work alongside nurses and depend on them to carry out care plans effectively, quickly, and cost-effectively.
Another assumption is that nurse leaders such as charge nurses can learn and develop leadership attributes (Thomas, 2016) that will help them improve their leadership style. However, leadership development can only take place if the organization is supportive and allocates appropriate resources and facilities. The third and last assumption guiding the conceptual basis of the initiative is that anyone and not just executives or managers can practice leadership (Smith-Trudeau, 2016). The main theme explored in these assumptions is leadership; it is an important systems theory factor and collaborative relationships are influenced by leadership styles. Although the connection between leadership and patient safety needs to be further evaluated, experts agree that certain leadership styles obtain better results than others do. In particular, experts have compared the effectiveness of transactional leadership against transformational leadership in achieving patient safety. Transactional leadership, as was observed in TGH, is not effective as it focuses on rewards rather than outcomes. Transformational leadership, on the other hand, possesses a higher level of competence that helps in guiding and motivating team members to follow a higher level of ethics and evidence-based care, thereby improving the outcomes for patients (Thomas, 2016). Transformational leaders are also more competent when introducing cost-reduction plans while Copyright ©2017 Capella University. Copy and distribution of this document are prohibited. QUALITY IMPROVEMENT INITIATIVE PROPOSAL 10 maintaining quality in their units. They are more skilled at organizational and administrative management, which is an essential skill for planning budgets, than transactional leaders. Transformational leadership is also the preferred leadership strategy in implementing systems theory approaches. Systems theory is important in QI as it helps understand the root causes and symptoms of quality and performance problems (Huber, 2017).
By understanding latent causes of quality issues, TGH can focus on proactive quality measures that prevent quality and safety issues in the long term. Such approaches are known to be cost-effective and sustainable. Transformational leadership’s focus on people through effective interpersonal relationships and charismatic influence are also beneficial for establishing collaborations among teams and developing optimum work–life quality for staff. The surgical units at TGH, consisting of interprofessional staff, depend on staff having a sense of shared goals. The nurses are the largest staff group in the surgical units and issues within their workforce such as nonalignment of goals affect other units’ staff. Transformational leaders are capable of guiding nurses in building respectful and positive relationships with their colleagues. These interprofessional perspectives will act as guides for the QI team when they implement the PDSA steps. The perspectives are especially useful in facilitating open and transparent communication. The QI proposal will suggest communication strategies that are imperative when expanding the proposal into a full-fledged QI program. The proposal will also provide assumptions that will guide those suggestions. Effective Communication Strategies to Promote Quality Improvement Communication is a key leadership duty and facilitates the smooth functioning of different organizational systems (Huber, 2017). Without effective communication methods, Copyright ©2017 Capella University. Copy and distribution of this document are prohibited
. QUALITY IMPROVEMENT INITIATIVE PROPOSAL 11 leaders will not be able to convey organizational goals and decisions or implement QI changes. At TGH, the charge nurses were not able to communicate care plans to their nursing staff or coordinate with other units’ leaders and interdisciplinary professionals to achieve ideal outcomes. Their ineffective communication methods also set a bad example for the nursing staff, who look to their leaders for guidance and instruction. Therefore, it is important to develop communication strategies before the QI strategies are implemented. Well-defined communication channels will promote interprofessional efforts in patient care and quality improvement. The assumptions guiding the strategies are as follows: (a) Leaders facilitate and mediate effectiv …