As health care consumers, we all expect quality care and positive outcomes. It is important as professionals that we meet these demands of health care consumers.
Defining Quality
As health care consumers, we all expect quality care and positive outcomes. It is important as professionals that we meet these demands of health care consumers. Consider the work of the major theorists you examined in this week’s Resources, and think about how these theories apply to your own experience as a health care customer and/or practitioner.
By Day 3
Post your definition of quality, and apply it to the work of one major quality theorist (e.g., Donabedian, Juran, Deming, Triple Aim (IHI) – Berwick). Identify a practice problem that you have had some experience with as a customer or as a practitioner, and explain how eliminating wasteful practices could have improved the experience. Include how your definition of quality applies to that experience.
Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level (see checklist).
Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old). (Refer to AWE Checklist, Capstone)
By Day 7
Read two or more of your colleagues’ postings from the Discussion question.
Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues’ postings.
Post a Discussion entry on three different days of the week.
NURS4220 Leadership Competencies in Nursing and Healthcare
Week 2 Discussion
Applying Measurement Tools
One example of a measurement tool is the Healthcare Effectiveness Data and Information Set (HEDIS) comprehensive care measures. Review the components of HEDIS comprehensive diabetes care; then consider the following scenario.
You are a staff nurse working in a private primary care practice. It is a small practice with 2 MDs (internists), 2 nurses, 1 medical assistant, and an office staff for billing. There are approximately 1,000 patients in the practice. You have had no EHR until the last year, but all charts are manual, historically. Your physicians are starting to inquire about quality incentives, particularly regarding patients with diabetes.
By Day 3
Take on the role of the staff nurse in the scenario, and post an explanation of how you would go about finding out how many diabetics are in your practice and how many meet all components of HEDIS comprehensive diabetes care.
Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level (see checklist).
Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old). (Refer to AWE Checklist, Capstone)
By Day 7
Read two or more of your colleagues’ postings from the Discussion question.
Respond to two or more of your colleagues’ postings with a critique of their data mechanisms. Explain whether the data mechanism is practical, how long it might take, any alternatives you might suggest, and/or any electronic data collection possibilities that might apply.
Post a Discussion entry on three different days of the week.
NURS4220 Leadership Competencies in Nursing and Healthcare
Week 3 Discussion
Applying Performance Improvement Tools
Read the following scenario:
Imagine that, for about a year, your nursing unit has been involved in an intensive campaign to improve patient satisfaction scores with pain management. You are getting good data from your patients, as the length of stay on this inpatient geriatric medical nursing unit is only about 6 days. Your hospital does 100% survey to inpatients, and the response rate is about 25%, which is higher than it has been. This notwithstanding, the percent of “patient very satisfied” (top box), with a score of 5, has been in the low 70s. The national benchmark for medical surgical units like yours is about 85% very satisfied. Of all the units in your hospital, your unit is the lowest scoring on this HCAPHS survey. But as your unit is the only geriatric medical nursing unit in the hospital, you’d always thought it was the nature of the patient population.
You have been the day shift representative to the QI team, and the scores on your unit are posted monthly. Here are the numerous strategies that have been tried on your unit and the timeframes.
Document: Strategies and Interventions (PDF)
For this Discussion, examine the strategies and interventions tried in your unit and consider the following questions: a) Were the strategies effective in creating a sustainable change on your nursing unit, and b) To what extent can your nurse manager and CNO count on your unit exceeding the national benchmark in the next quarter, the next year? That is, does this run chart have some predictive ability? Does the run chart support the nursing unit’s decision to celebrate? To what extent can the leadership be confident that the trend will continue?
By Day 3
Based on the scenario, explain what was done successfully and where improvement was needed in the quality improvement process. Identify the performance improvement tools, and explain how they contributed to the outcome.
Support your response with references from the Resources and professional nursing literature. Your posts need to be written at the capstone level (see checklist).
Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old). (Refer to AWE Checklist, Capstone)
By Day 7
Read two or more of your colleagues’ postings from the Discussion question.
Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues’ postings.
Post a Discussion entry on three different days of the week.
NURS4220 Leadership Competencies in Nursing and Healthcare
Week 4 Discussion
Root Cause Analysis
Review the case scenario included in this week’s media resources, and examine the process flow chart, cause/effect diagram, and Pareto chart related to the case scenario.
In the scenario, the nurse manager and the director of pharmacy blame each other for the error. The facilitator (quality assurance person) asks everyone to avoid blaming and focus on applying the tools to analyze the data and get to the root cause of the error. While all of these tools contribute, for this Discussion, select one tool to analyze.
By Day 3
Post each of the following:
Analyze the composition of the RCA team. Explain what knowledge they can contribute to the RCA.
Describe the collaboration in the case study that led to effective problem solving. Identify the evidence you observe in the scenario that demonstrates effective collaboration and the avoidance of blaming.
Explain the team’s process in testing for and eliminating root causes that were not contributing.
Select one of the performance improvement charts presented in the scenario and critique its effectiveness by explaining how it contributes to identifying the root cause and determining a solution to prevent repeat medication errors.
Identify the contributing factors, and discuss how to prevent this kind of error from occurring in the future.
Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level (see checklist)
Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old). (Refer to AWE Checklist, Capstone)
By Day 7
Read and respond to the postings of two or more of your colleagues’ who discussed different charts, identified different evidence of positive collaboration, and/or identified different contributing factors than you did. Also offer comments that ask for clarification, provide support, or contribute additional information. Offer alternative viewpoints on the cause as you see it.
Post a Discussion entry on three different days of the week.
NURS4220 Leadership Competencies in Nursing and Healthcare
Week 5 Discussion
Leadership Strategy
As a nurse, you serve an important role in identifying strategies to effectively manage health care resources and in leading health care quality improvement. You must be able to decide what leadership style or strategy to apply in a given situation to achieve an effective resolution of the issue. Read the following two scenarios and select one to focus on in this Discussion. Consider the leadership style or strategy that might be most effective in the scenario you selected.
Scenario 1
You work in a for-profit nursing home, with about 100 beds, on a 20-bed unit that is largely patients with Alzheimer’s disease. Your patient mix is predominantly Medicare and Medicaid patients. Your nursing home is part of a larger system that includes a major medical center, as well as VNA, outpatient dialysis, and a fully integrated network. Your nurse manager is getting feedback from the hospital that your nursing home is sending too many patients to the ED who really don’t need to go. How would you go about figuring out what could be done at the nursing home to prevent avoidable ED visits?
Scenario 2
You’ve been associated with an outpatient cardiology clinic that is part of a large academic medical center. Your patients are mostly charity care and managed Medicaid. Most have a prescription plan, but none have a “family doctor” and use the clinic (and the ED) regularly. Most are unfamiliar with their medications and do not have the resources for care coordination in their family/social network. About 25 CHF patients have been “lovingly,” but inappropriately, called “frequent fliers” because of their inability to manage their own care, their frequent visits to the ED, and their “one night stays” paid at the observation rate. As a staff nurse in this clinic, describe the strategies you could devise for you and your fellow staff nurses targeting these 25 patients. Find at least one article from the professional literature to corroborate your recommendations.
By Day 3
Select one of the scenarios, and post the following:
Describe the most appropriate leadership style and/or strategy to apply in the scenario you chose in order to implement the recommendations successfully. Justify your selection.
Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level (see checklist)
Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old). (Refer to AWE Checklist, Capstone)
By Day 7
Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).
Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues’ postings.
Post a Discussion entry on three different days of the week.
NURS4220 Leadership Competencies in Nursing and Healthcare
Week 6 Discussion
The Nurse’s Role in Promoting Quality Health Care
As you have noted in this course and in your practice, nurses have an integral role in promoting a just culture focused on patient safety in their health care organizations. Determining resources to prevent error and improve patient safety can often be a battle, and this scenario illustrates how one organization makes strides to make sure resources are available in the interest of patient safety. As you review the scenario, consider the nurse’s role in promoting a just culture in your practice setting.
By Day 3
Post a description of the role of the staff nurse for promoting quality in a high-performing health care organization. Define the organizational culture of your health care organization, or one with which you are familiar, and identify the leadership style of the CEO and CNO in your organization. Explain how your senior leadership supports—or does not support—changes that require financing/budget to support patient safety. Describe the strategies you might be able to implement to move your health care organization to a high-performing organization.
Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level (see checklist)
Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old). (Refer to AWE Checklist, Capstone)
By Day 7
Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).
Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues’ postings.
Post a Discussion entry on three different days of the week.
NURS4220 Leadership Competencies in Nursing and Healthcare
Week 1 Practice Experience Discussion
In this week’s Discussion, you shared your experiences with health care practice problems as a consumer and/or as a practitioner. Now, consider your current practice setting and think about something specific and relevant to your practice setting that you would like to see improved or changed. Interview a key leader in your practice setting who can confirm that your practice problem is one that should be addressed to enhance delivery or performance in the field. It is important to remember from the beginning that your practice problem must be measurable, and that you identify data that suggests a problem exists, and although this comes up more specifically in Week 2, it is important to consider this from the start.
This will be the problem discussed in your Practice Experience Project, Capstone Paper, and Storyboard.
NURS4220 Leadership Competencies in Nursing and Healthcare
Week 2 Practice Experience Discussion
Applying Measurement Tools to a Practice Problem
Conduct a collaboration interview with two or three key leaders in your practice setting to determine the measures for your practice problem and associated challenges impacting measurement for your practice problem (include confidentiality, anonymity, access issues, etc.). Perform an existing evidence review on your practice problem and search for evidence that demonstrates how your practice problem is measured across the country.
NURS4220 Leadership Competencies in Nursing and Healthcare
Week 3 Practice Experience Discussion
Applying Process Improvement Models
Choose a Quality Improvement Model from Chapter 5 in the Spath (2018) textbook, and apply this model to your practice problem. Please do not choose Lean or Six Sigma as your quality model unless you have an expert in these quality models in your organization to guide you through the process.
PDSA (p.124).
RCI (p.127).
FOCUS PDCA (p.128).
FADE (p.129).
NURS4220 Leadership Competencies in Nursing and Healthcare
Week 4 Practice Experience Discussion
Stakeholder Analysis
The next step in the process is to begin identifying the challenges and impediments to implementing a quality improvement plan. In the analysis consider the individuals affected by the change as well as the cost of implementing the quality improvement plan.
NURS4220 Leadership Competencies in Nursing and Healthcare
Week 5 Practice Experience Discussion
Applying Key Interventions to a Practice Problem
The final step is to develop the plan discussing the steps clearly and succinctly. The plan must be evidence based .
NURS4220 Leadership Competencies in Nursing and Healthcare
Week 3 Assignment
Capstone Paper, Part I: Introduction, Analysis of Existing Evidence, and Quality Improvement Process
The Assignment you will submit this week will combine the work you completed in Week 1 (Introduction) and Week 2 (Analysis of Existing Evidence) and this week’s assignment, the Quality Improvement Process. These three sections, when combined, will complete Part I of your Capstone Paper.
To prepare for this Assignment:
Review the Capstone Paper Assignment Guide
Locate the most current version of your Week 1 and Week 2 Assignment. You will add this section to that document.
Review the Academic Writing Expectations Checklist Capstone Level
Note the new expectations for Use of evidence and Credit to Source
Use a Scholarly Voice
http://academicguides.waldenu.edu/writingcenter/scholarlyvoice
http://academicguides.waldenu.edu/writingcenter/webinars/scholarlywriting#s-lg-box-2773859
Review the Walden University Writing Center webpage: Using Evidence: Synthesis
Review the Week 3 Assignment Rubric
Remember: Each section of the Capstone Paper must meet the Academic Writing Expectations for the Capstone Level.
For this Assignment
Describe the quality improvement process and the Quality model that will be used as a basis for the practice problem. Include a description of a quality improvement tool(s) that you will use in your quality improvement plan. See Spath, (2018) chapter 6 for examples.
Explain why the specific process was selected and document your explanation with references.
For the Week 3 Assignment, you will combine your Week 1, 2 and 3 assignments and submit a 3-4-page paper that addresses the following:
Practice Problem (Completed in Week 1)
State the practice problem in measurable terms.
State the data that suggests a practice problem exists
Include a purpose statement.
Analysis of the Existing Evidence (Completed in Week 2)
Summarize the findings from the evidence analysis that support your practice problem. Include minimum of at least 5 evidence-based practice sources that support your practice problem. Identify research, clinical guidelines, expert opinions, and other relevant information. You must include two-three research studies in your analysis. Using your own words synthesize the evidence that supports your identified practice problem. There should be no quotes or personal opinions included in this section.
Quality Improvement Process (Completed this Week) (Approximately 2-3 paragraphs)
Describe the quality improvement process and the quality model that will be used as a basis for the practice problem. This is not your entire quality improvement plan, only a description of the quality improvement process and the quality model you chose. You will develop your specific quality improvement plan in week 4. Include a description of a quality improvement tool(s) that you will use in your quality improvement plan. See Spath, (2018) chapter 6 for examples.
Explain why the specific process was selected and document your explanation with references.
Conclusion
By Day 7
Submit your Assignment.
Submission and Grading Information
Naming Convention for Saving Your Assignment
Please save your Assignment using the naming convention “WK3Assgn+last name+first initial.(extension)” as the name.
Click on the Submit button to complete your submission.
NURS4220 Leadership Competencies in Nursing and Healthcare
Week 5 Assignment
Capstone Paper, Part II: Quality Improvement Plan, Resources and Conclusion
In week 5 you will write the final section your Capstone Paper. The Assignment you will submit this week will combine the work you completed in Week 4 (Evidenced-Based Practice Plan) and will integrate the Resources and Conclusion details in approximately 3-5 paragraphs for your Capstone Paper. Be sure to include scholarly references identified in the literature review to support your EBP plan. Use appropriate and persuasive language that communicates meaning with clarity and fluency to readers, and is virtually error-free (see AWE Capstone Checklist).
To prepare for this Assignment:
Review the Capstone Paper Assignment Guide
Locate the most current version of your Week 4 Assignment. You will add these sections to that document.
Review the Academic Writing Expectations Checklist Capstone Level
Note the new expectations for Use of evidence and Credit to Source
Use a Scholarly Voice
http://academicguides.waldenu.edu/writingcenter/scholarlyvoice
http://academicguides.waldenu.edu/writingcenter/webinars/scholarlywriting#s-lg-box-2773859
Review the Walden University Writing Center webpage: Using Evidence: Synthesis
Review the Week 5 Assignment Rubric
Review Chapter 5 in your Spath text for examples of practice improvement plans.
Spath, P. (2018). Introduction to healthcare quality management (3rd ed.). Chicago, IL: Health Administration Press.
Refer to Writing Center guidelines for how to write a summary.
Remember: Each section of the Capstone Paper must meet the Academic Writing Expectations for the Capstone Level.
Write a 3–4-page paper that addresses the following:
Introduction. Briefly review your practice problem and include a purpose statement.
Evidence-Based Practice Plan Explanation (Completed in Week 4)
Provide a detailed explanation of the evidence-based practice performance improvement plan that you will be use to address the practice problem.
Support your plan with scholarly references (the sources you found in the analysis of the evidence).
Resources (completed in Week 5)
Describe the resources needed to support the change in practice such as personnel time, supplies for staff education, cost of new equipment, or cost of software.
Explain why each resource is necessary.
Conclusion
Discuss all key points addressed in this assignment.
NURS4220 Leadership Competencies in Nursing and Healthcare
Week 6 Assignment
Quality Improvement Storyboard
Storyboard Instructions
The Practice Experience Project Storyboard is a brief, visual summary of a completed quality improvement initiative. The storyboard highlights key aspects of a quality improvement effort by documenting the Practice Experience Project from beginning to end.
The course template uses a PowerPoint format to complete this assignment. You only need to provide two slides, no more. The first slide is the summary of your project; the second slide is the reference page. You will need to choose the most pertinent information from your practice experience and Capstone Paper to complete the Storyboard. No voiceover is required.
The completed storyboard is submitted for grading. Optional: You may submit your storyboard to the group discussion area and share your presentation with your classmates and instructor.
By Day 4
Submit your quality improvement storyboard using the provided template.
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