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.
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.
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
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