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Adapting to Change. Health Environments Research & Design Journal (HERD)

What is Quality Improvement?

Quality improvement (QI) and research have very different functions in healthcare. The purpose of QI is to use data to improve processes and or outcomes. The QI process has its roots in organizational philosophies, total quality management and continuous quality improvements processes. A key component of developing a QI plan is to identify the outcome to be measured, then developing a plan and collecting data before and after the intervention.

 

Research, on the other hand requires extensive literature reviews and critical appraisal. The intent of doing research is to provide new knowledge using quantitative and qualitative methods to produce best evidence. Nurses are typically more involved in QI projects than they are in research activities. Some examples of QI projects include implementing a process to remove urinary catheters within a certain time frame, developing a process to improve patient pain documentation, and improving the process for patient education for those patients with congestive heart failure. The key to developing a QI plan includes clearly defining the outcome that needs to be improved, identify how the outcome will be measured, and develop a plan for implementing an intervention and collecting data before and after the intervention. This assignment reviews some important components of a QI plan.

 

In this Module, the student will create a QI plan. This plan will continue in Module seven. In this Module, the components of this QI plan include the development of:

 

Write about a medical condition that interest you (read the example below)

 

  1. Problem and significance of a topic;
  2. Recommended changes from the literature;
  3. Change theory; and
  4. Creating teams, aims and measures.

 

 

                                    Directions for Quality Improvement Project

 

 Leadership and Management Module Five & Seven

The intent of this assignment is to have the student become familiar with the Quality Improvement (QI) process and be exposed to some useful tools that will help with QI projects. Some examples are provided to assist students in parts of this assignment, the examples are in red font. First, the student should visit the Institute for Healthcare Improvement (IHI) website (http://www.ihi.org/topics/Pages/default.aspx) and select a topic for their QI project.

In Module 5, you will write about the topic and cover the below content. Like all professional papers, the paper should be in the American Psychological Associate (APA) template. The expectation is the APA formatting, references in text and in the reference page should be in proper format. To begin, the introduction of the paper should state some brief information about the project, along with a purpose. The reader should be able to understand the intent of the project in the introduction. After you submit your paper in Module five, the instructor will review and return with a grade. The expectation is that you will make the recommended changes when submitted in Module seven. Next, each of the following items need to be addressed:

 

  1. Problem and Significance
  2. What specifically is the problem identified in this project, please state so explicitly. For example, state something like “The identified problem in this Quality Improvement Project is…” Back up the need for doing this QI project with three references from scholarly sources that describe the:
    • Magnitude of the problem;
    • Identify the specific need for improvement; and
    • Identify a gap in recommended practice and current practice. For example, if you are writing about a literature review that states intravenous dressings should be changed every three days and your practice does not comply with this, this would be the gap in practice. A gap in practice could also be a facility or facilities not following the recommended guidelines.

Example       

           

Introduction

In the United States, thousands of people are diagnosed and living with congestive heart failure (CHF) each year. The identified problem in this project is the lack of standardized care for patients who suffer from CHF.  CHF is defined as “ A condition in which the heart fails to pump an adequate supply of blood to meet the body’s needs (Institute for Health Care Improvement [IHI}, 2008, p. 3).  For those who live with CHF, the course of treatment is often long term, taxing to the patient, the family and puts a strain on an already taxed healthcare system. Standardizing a plan of care for these patients may help the patient and family maintain a better quality of life and decrease the long-term cost of care. The purpose of this paper is to…..

 

Problem & Improvement

Living with CHF presents many obstacles for the patient, the family and the healthcare system. Jones and Smith (2018) found that four million people suffered from CHF in the United States between 2002 and 2012. Fifty two percent of those patients had a 75% chance of readmission to the hospital within the first month of being discharged. This cost represented four billion dollars spent on patients who suffered from this affliction (Doran, 2017). This wide spread problem puts a large strain on the healthcare system. Additional literature suggests that those patients with CHF suffer a poorer quality of life, due to frequency of hospital visits and financial strain (Algood & Jackson, 2018). Regarding the impact on those with CHF, The Institute for Health Care Improvement (2008) found:

CHF carries with it a substantial human toll. The debilitation from the condition itself significantly affects the person’s ability to function in daily life. Yet, because of inadequate treatment, discharge guidance and follow-up, many patients with CHF are caught in a “revolving door” process that ultimately culminates in deterioration and rehospitalization. This is reflected in the following readmission rates among 616,000 Medicare discharges in 2005: 27% within 30 days, 39% within 60 days, nearly 50% within 90 days of hospital discharge (p.22).

For these reasons, a standardized plan of treatment is appropriate and recommended by multiple authors in the literature. Current research has suggested that those patients with CHF who followed a standardized plan of care had a significant increase in quality of life, as compared to those who do not follow a standardized plan of care (Martin, 2019). Additional research suggests that if all facilities followed a standardized plan of care or treatment for these patients, the healthcare system would save four billion dollars a year (Dumont, 2019).

 

Gap & Best Practice

According to the literature, there is an identified gap in recommended and current practice. Many of our nation’s hospitals are not following recommended guidelines set forth from the IHI. Martin (2017) found that only 30% of hospitals follow the current recommended guidelines for the treatment of CHF. Add two more references. This information details a need to change practice. Best practices identified by the IHI include seven key care components. Make sure your paragraphs are substantive and clearly explain items. The best practices are superior to current practice because evidence in the literature substantiates a better quality of life for patients along with cost savings.

 

  1. Recommended Changes

What are the recommended changes needed in practice found in the literature? Tell the reader what changes are needed in practice compared to current evidence. If current practice is similar to the literature, tell the reader what could be done to monitor and maintain best practices.  This section should be at least one page. List three recommendations found in the literature in bullet points. Identify exactly what needs to be changed. For each recommendation, tell the reader whether it is a change in knowledge, skill or attitude.

 

Examples

  • The IHI has identified seven key care components recommended for all CHF patients. These recommendations are as follows:
    • (System wide). The most notable recommendation calls for a left ventricular systolic function assessment. This should be done on admission to the healthcare facility and become part of the care plan for all CHF patients. Developing a team to identify the best method to implement this recommendation would be appropriate during the planning section of this project. In addition, physicians, all licensed health care providers should be aware of this recommendation. Educational sessions for this recommendation should be done for all nursing units prior to the implementation of the plan. In addition, it would be helpful to add this item to each patient’s care plan while in the hospital and also to the care pathway if used. This would be a change in knowledge and attitude.
    • The second recommendation is the prescribing of an ACE-inhibitor or angiotensin receptive blocker (SRB) at discharge for CHF patients with systolic function <40%. The is recommendation should be included in an educational program for all licensed health care providers and physicians prior to the implementation of the plan. In addition, it would be helpful to add this item to each patient’s care plan while in the hospital and also to the care pathway if used. This would be a change in knowledge and attitude.
    • The third recommendation is the prescribing of an anticoagulant medication at discharge for CHF patients with chronic or recurrent atrial fibrillation. This recommendation should also be included in an educational program for all licensed health care providers and physicians prior to the implementation. In addition, it would be helpful to add this item to each patient’s care plan while in the hospital and also to the care pathway if used. This would be a change in attitude and knowledge.

 

  1. Change Theory

(No example)

What change theory would you use to implement this Quality Improvement project? The text has many different examples of these types of theories.  This is a very important part of the project because if you are not aware of how to make change happen or the stages of change theory, the project may not be successful. In this section:

  • Define the change theory with a reference;
  • How would you use the change theory to implement the recommendations? Then tell the reader what would happen in each stage of the theory;
  • If this Quality Improvement project was intended to implement a new guideline for the care of CHF patients and Lewin’s Change Theory were being used what would happen during the unfreezing, moving and refreezing stages in this project? What are the driving and restraining forces? What could be done to mitigate failure?

.

 

  1. Team, Aims and Measures

 

(No example)

 

After visiting the Institute for Health Care Improvement (IHI) website at http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.aspx review the Model for Improvement and its various sections.  With your project in mind, respond to the following questions in paragraph form:

  • How would you form a quality improvement team and what are some items to consider when forming the team? What disciplines should be on the team and why?; and
  • Click on the Setting Aims headings and read the content. How would you set aims or specifically what does the IHI recommend about setting aims? What are the six overarching items for setting aims according to the IHI?
  • List at least three aims in bullets for your project. Make sure they are measurable and time specific.

 

 

Readings and Resources

  • Read: Chapter 8- Planned Change. Marquis. B.L. & Huston, C.J. (2017). Leadership roles and management functions in nursing. (9th ed). Philadelphia, PA: Wolters Kluwer.

 

  • Read: Chapter 13- Organizational Political and Personal Power. Marquis. B.L. & Huston, C.J. (2017). Leadership roles and management functions in nursing. (9th ed). Philadelphia, PA: Wolters Kluwer.

 

  • Read: Barley, E., & Lawson, V. (2016). Using health psychology to help patients: theories of behaviour change. British Journal Of Nursing, 25(16), 924-927.

 

  • Read: Stichler, J. F. (2011). Adapting to Change. Health Environments Research & Design Journal (HERD) (Vendome Group LLC), 4(4), 8-11.

 

 


 


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