Attention Catherine Owens Week 5

Attention Catherine Owens Week 5

Quality improvement (QI) can be defined as the effort to better patient outcomes, system

performance, and professional development (Batalden & Davidoff, 2007). The Institute of

Medicine (IOM) has challenged professionals to improve healthcare quality, with quality

described using the following six domains: safety, timeliness, effectiveness, efficiency, equity

and patient-centeredness. These quality aims provide a framework for focusing improvement

efforts. The unrelenting engagement of all providers is required to transform healthcare. APNs

are well positioned to lead quality initiatives by virtue of their advanced knowledge and

preparation. To effectively lead quality improvement requires understanding that organizations

are complex adaptive systems; dynamic, unpredictable, and are composed of moving parts.

Knowledge of theoretical underpinnings of change (theory explicating the phenomenon of

human behavioral change) is foundational to successful improvement. A wide variety of QI

models, tools, and methods are available to guide the APN in facilitating improvement.

In his book, The Seven Habits of Highly Effective People, Stephen Covey reminds us to

“begin with the end in mind”. Dr. Covey is talking about people’s personal quest for

improvement. However, wouldn’t the same apply to quality improvement matters? The

question is rhetorical and the answer, of course, is “yes”. Before we decide what to do, we must

decide where we are going. If you have not determined where you are going, then how do you

know when you have arrived, or how close you are to getting to your destination?

In quality improvement, we refer to our destination as outcome measures. Most

outcome measures are downstream, meaning changes in outcomes are achieved over time and

confounded by multiple variables. Process measures are a means to an end. In other words,

processes are the activities that affect the outcome measure. For instance, if one wanted to

improve patient satisfaction (an outcome measure) the variables affecting patient satisfaction

would be examined. One such variable may be the process of communication from the patient to

the nurse for patient calls. Perhaps, the first thing the change agent would do is to assess the

nurse response time to patient calls (process measure). It may be important to correlate the

response time to the hour of the day or the day of the week.

The investigator would look for

variability (how wide the range) in response times and understand the more variability in the

process, the more complex and the more unpredictable the outcome. Standardization of

processes decreases the variability of process outcomes and promotes the likeliness of

improving downstream outcomes.

Rev 12/18

I suspect that you already understood all of this, right? It makes perfect sense. Before

we move forward, I want to emphasize a few essential points. First, when facilitating process

improvement, it is essential to understand the complexity of a practice concern and theprocesses

influencing outcomes. We often use tools to help us understand the problem, such as a fishbone

diagram, a flowchart, a root cause analysis, a failure mode effect analysis or other similar

tools. If one doesn’t take the time to understand the issue, improvement strategies, regardless of

their evidence-base, do not have a chance of success. Attention Catherine Owens Week 5

Facilitating process improvement requires a “systems thinker”, one who focuses on the

system and processes and not the person. A systems thinker recognizes that to err is human, so

he/she attempts to build safeguards into processes to reduce variability of outcomes. Once

serving as a legal nurse expert I reviewed a case where a nurse mistakenly gave four times the

prescribed dose of digoxin. Subsequently, the patient experienced a cardiac arrest and although

revived suffered long term consequences. It is easy to look at a situation and criticize the nurse

for the error. Why everyone knows the toxicity of digoxin. How could anyone be so

careless? A systems thinker looks differently at the error. The system thinker looks for system

breakdowns. For instance, why was this large dosage of digoxin available to the nurse? What

was the procedure for pharmacy to check physician orders for drugs before administration? Was

there a nurse double check system in place to reduce nurse administration errors? If yes, was it

being used? If the double check policy was not being practiced, were there obstacles preventing

use of this safeguard? Were alerts available to warn nurses against this dosage of medication? In

other words, where were the safeguards to protect against human error? What process failures

contributed to the medication error?

Lastly, when selecting the process measures, consider the logistics and difficulty of data

collection. Nursing occurs in real time with real people. Human resources are limited. Asking

nurses to do one more thing will probably get someone tarred and feathered. Look for

measurements already in place so data can be easily obtained.

Rev 12/18

Assignment

For this assignment select a practice improvement issue within your organizational

system and within the realm of your practice area. Using the grading rubric as a

guide, develop a quality improvement plan to address the identified issue. The

purpose of this paper is to demonstrate knowledge of the essential elements of

quality improvement, with change theory as an underpinning for the process.

Do not use a quality intervention plan that has already been implemented for

this assignment; this should be a new plan for the organization with a clear

measurable problem statement and a planned evidence-based intervention.

Students are not expected to implement the plan; however, the process for

implementation and evaluation is addressed as part of the planning process.

The paper should be carefully written in a formal style, based on primary sources,

provide an integration of ideas, and be 5 to 6 pages in length, excluding title page,

appendices & reference list. Organized flow, logical progression of ideas, and clarity

in thought are essential.

Please use headings consistent with the topic areas of the rubric to separate content.

References must be timely; published within the previous five (5) years. Liberal

number of primary and peer reviewed references (minimum of 10). This paper must

be submitted to Turnitin; the similarity report must be attached to the assignment as

the last item in the submitted pdf file. Attention Catherine Owens Week 5