NURS 8300: Organizational and Systems Leadership for Quality Improvement | Week 7

In Week 6, you explored quality improvement models as a strategy for identifying health care and patient safety concerns. Once a quality or safety issue is identified, what is the next step to ensure the issue is improved? What internal and external organizational factors will influence the success, or failure, of a quality improvement initiative?

The concepts presented this week relate to how nurse leaders can develop quality improvement initiatives that align with the mission, vision, and values of the organization to engender success and achievement of the goals.

Learning Objectives – NURS 8300 Week 7: Quality Improvement Initiative Nursing Paper

By the end of this week, you will be able to:

• Assess how the mission, vision, and values of the organization determine improvement priorities
• Apply the SMART criteria to a quality improvement initiative
• Analyze the influence of the external environment on the priorities of the organization

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Joshi, M.S., Ransom, E.R., Nash, D.B., & Ransom, S.B., (Eds.). (2014). The Healthcare Quality Book, 3rd ed. Chicago, IL: Health Adminisration Press.

• Chapter 11: “Patient Safety and Medical Errors”

Clarke, C. M., & Persaud, D. D. (2011). Leading clinical handover improvement: a change strategy to implement best practices in the acute care setting. Journal of Patient Safety, 7(1), 11–18. doi:10.1097/PTS.0b013e31820c98a8

Designed for leaders who want to improve quality care, this article focuses on clinical handovers that occur within acute care facilities. It provides a model for improvement and is intended to be a supplemental resource that can be used with the existing research and literature on this topic.

Sennett, C. (2010). Healthcare reform: Quality outcomes measurement and reporting. American Health & Drug Benefits. Retrieved from http://www.ahdbonline.com/article/healthcare-reform-quality-outcomes-measurement-and-reporting

The article on this website discusses features of the Patient Protection and Affordable Care Act (PPACA), focusing on the outcomes and implications for quality outcomes measuring and reporting.

Required Media

Laureate Education, Inc. (Executive Producer). (2011). Organizational and systems leadership for quality improvement: Organizational priorities for quality improvement. Baltimore: Author.

Note: The approximate length of this media piece is 9 minutes.

This video provides an overview of organizational factors that influence quality. Lillee Gelinas discusses the importance of teamwork and enlisting leadership to help move quality initiatives forward. Other topics addressed include the role of stakeholders in improving patient safety and the responsibility of hospital board members in setting the quality and safety agenda.

Optional Resources

Lazarus, I.R. (2011). What will It take? Exploiting trends in strategic planning to prepare for reform. Journal of Healthcare Management, 56(2), 89–93.

Discussion: Quality Improvement Initiative

When attempting to garner support for a quality improvement initiative, it is important to demonstrate how the initiative supports the organization’s mission, vision, and values, as well as external factors that influence an organization’s priorities. Delivering a proposal for a quality improvement initiative requires clear, concise communication of the plan.

To prepare:

• Choose a QI initiative which has been the subject of focus in any healthcare setting. Explain the rationale that your senior leaders used in selecting this initiative for attention and focus.
• Explain how adverse events are handled in your organization from the public’s perspective and well as internally.
• Find a scholarly article or one from the public press, published within the last 5 years which recounts a serious error. Relate this error to any organization with which you have some familiarity.

By Day 3

Post your response.

Read a selection of your colleagues’ responses.

By Day 7

Respond to two of your colleagues in one or more of the following ways:

Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.

Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.  Quality Improvement Initiative Nursing Paper

ADDITIONAL INFORMATION 

Determining Organizational Priorities for Quality Improvement

Introduction

It’s a good idea to think about where you want to make improvements in your organization. If you don’t, then it might be easy for the people around you—including yourself—to lose sight of what matters most. When selecting an area for improvement, consider how it will affect members and the health care system as a whole (i.e., cost savings vs. improved quality).

Determine the organization’s strategic goals.

• Strategic goals must be SMART. This means that they should be specific and measurable, with time-bound targets. For example, a goal might be “improve customer satisfaction” or “lower costs.” These are not clear enough to gauge success against them. They also don’t communicate what your organization will do to achieve the targeted results; how you’ll measure whether or not those goals have been met; or how long it will take for them to be reached (in this case, if all goes well).

Gather quality data.

Gather quality data. Quality improvement is a process of identifying, analyzing, and addressing problems that have the potential to affect patient care. To do this successfully, you must first collect quality information about your organization’s performance in order to gain insight into where improvements could be made.

• Use data collection instruments such as questionnaires or surveys to collect information from staff members regarding their perceptions of patient satisfaction and other factors related to effective practice (such as learning curves).

• Analyze this information using statistical analysis tools such as regression analysis or factor analysis so that you can identify groups within your organization who perform better than others on certain measures related to quality outcomes like infection rates or length of stay after surgery

Rate and rank your priorities for improvement.

You can use data and metrics to determine the priority areas for improvement in your organization. By taking the time to gather accurate information about your current state, and by using it as a guide when creating goals for improvement, you’ll be able to make informed decisions about what matters most.

In order to prioritize areas for improvement, you’ll need some sort of data on which you can base your rankings. The best way is probably using an established process—one in which there has been enough investment from all involved parties that anyone involved knows how everything works (and thus doesn’t feel like they’re being roped into something). For example: if you have staff members who report directly into someone else at their organization’s headquarters every day via email communication or other means; if these reports include any type of quantitative information such as number lines associated with certain metrics; then perhaps this would be an appropriate place where everyone could share knowledge about what’s going well/not so well within each department within their own group structure?

Identify barriers to quality improvement.

To start, you need to identify barriers to quality improvement. Barriers can be financial, cultural or structural. For example, if you have a shortage of resources and don’t have enough qualified people on your team then it’s likely that the organization won’t be able to deliver its promised results. Or perhaps there are political issues at play that make it difficult for managers or employees with new ideas about how things should be done in order for the organization’s goals related to quality improvement (and ultimately profits) are met.

On top of these organizational issues there may also be personal ones: lack of knowledge within an area could mean that someone doesn’t know enough about how something works or why certain actions might lead towards better outcomes rather than worse ones!

Evaluate how resources can help you overcome barriers to quality improvement.

Evaluate how resources can help you overcome barriers to quality improvement.

The purpose of this step is to identify the resources that are most important and make sure you have the resources you need. These include:

• The people who will be involved in implementing your change, including their skills and knowledge.

• The processes that are used at your organization (e.g., planning, monitoring).

You should also consider any potential barriers that may interfere with your ability to implement a change program or process improvement initiative (e.g., time constraints).

Choose a goal that’s achievable but challenging.

Choosing a goal that’s achievable but challenging is an important step in the process of developing a plan for quality improvement. This is because it helps you to set goals that are not too easy or too hard, and therefore will have a meaningful impact on your organization’s quality of care. In addition, choosing a goal that can be accomplished within 12 months allows you time to implement changes before they become obsolete.

Choose a goal that will have a meaningful impact on the quality of care you provide to members.

Once you have identified the problem, you must choose a goal that will have a meaningful impact on the quality of care you provide to members. When considering your options, consider these criteria:

• The goal should be specific, measurable and achievable. For example: “We want our electronic records to be complete by July 31st” may not be specific enough for many organizations; however, if your organization has been experiencing problems with patient records being incomplete or missing information due to staff errors or computer crashes (or both), this could be an achievable goal for your organization.

• The goal should also be realistic and timely—meaning it has potential for immediate improvement over time as well as long-term benefits that will continue beyond any single project or initiative. This means focusing on both short-term improvements in order to meet shorter deadlines while also establishing long-range goals that take into account longer term changes such as rethinking how we do things today versus tomorrow

Determine which changes will have the greatest positive impact on your members’ health and experience of care.

Determine which changes will have the greatest positive impact on your members’ health and experience of care. In order to determine this, you should focus on areas that will have the most impact on members’ health and experience of care. For example, if you are a unionized facility, then it is important to target issues such as working conditions or pay-for-performance incentives because these can directly affect employee morale and performance at work. However, if you are an outpatient surgery center (OSC), then it may be more appropriate for OSCs to focus on improving patient safety rather than improving how much money they make per hour worked by their employees.[1]

In addition to determining which areas need improvement first based on these criteria above (ease/cost effectiveness), there are some other factors that must also be considered when determining what type of change should be made first: feasibility/stability/sustainability

Prioritize opportunities to reduce cost while maintaining or improving quality.

It’s not enough to say that quality improvement is about reducing cost. You need to think about how you can do this while still maintaining or improving quality.

Here are some key questions to ask:

• What cost-reducing opportunities exist?

• How much could we reduce our costs by doing so?

• What would it mean for patient care if we were able to reduce those costs?

When choosing an area to improve, consider the impact on members, cost and feasibility.

When choosing an area to improve, consider the impact on members, cost and feasibility.

• Impact on members: One of the most important factors in determining which areas should be prioritized is how much work it will take to implement changes in those areas. For example, if you have a process that takes 4 hours per week and there are 25 people involved in this process, then implementing quality improvement measures could mean taking time away from other tasks or projects that need your attention (and therefore lowering their effectiveness). If this doesn’t seem like an issue for your company at all times then go ahead and add it as a priority—but keep in mind that there may be other things competing for limited resources such as new products or services being developed by others within the organization.

Conclusion

As your organization moves forward with improving quality, remember that there are many factors to consider when choosing an area for improvement. If you feel overwhelmed by all of the options, it’s important to remember that a perfect solution may not be available. Instead, this process can help you identify priorities and make choices that will have a positive impact on your members’ health and experience of care.