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RESEARCH PAPER ON QUALITY IMPROVEMENT in health care
Importance Of Quality In Healthcare
RESEARCH PAPER ON QUALITY IMPROVEMENT in health care
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Elements of an Organizational Model of Health Care Performance, Quality Assessment, and Management
Quality care, safe practices and principles, and accountability constitute the foundation of any health care organization (Huber, 2014). Addressing patient safety issues and improving health care quality may include reorganizing operations to improve efficiency, coordinating care with interdisciplinary team members, and using information technologies (Wang, Cha, Sebek, McCullough, Parsons, Singer, & Shih, 2014). In this paper, I will review my organization’s quality program goals, objectives, and management structure, how quality improvement (QI) projects are selected, managed, and monitored, and how nursing staff are trained and supported in
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the QI process. I will also describe methodology and tools/techniques used, how QI activities and processes are communicated to staff and evaluated, and provide two examples of QI initiatives that have been effective in our organization. Quality Program Goals, Objectives, and Structure In our organization, the Quality Improvement (QI) Department is within the Quality and Patient Safety Institute.
The goals are to “provide high quality care and continuously improve our performance.” The four main focuses are: 1) preventing hospital acquired infections, 2) contributing to developing and implementing the Cleveland Clinic Integrated Care Model by delivering care coordination and care path projects within the Value Based Care strategic initiative, 3) avoiding preventable harm to patients and caregivers, and 4) delivering data and projects that support the operational needs for organizational quality and safety, including performance and regulatory reports, system administration and design, accreditation support, patient safety support, and clinical risk management (Cleveland Clinic, 2015). The QI team “enhances value across the enterprise, including patient care, outcomes, and cost, by collaboratively delivering projects and infrastructure aligned with Cleveland Clinic strategies” and the two major components are project management and data analysis that work together to “support clinical safety and quality improvement efforts.” The Chief Quality Officer is over the Quality and Safety Officer. Under that are the Administrative Program Coordinator, Administrative Director, Department Coordinator, and Institute Administrator. Additionally, there are Institute Quality Directors who manage QI for their particular institute, for example Cole Eye Institute or …show more content…
Digestive Diseases Institute and within each institute is a QI Officer for each department. Quality Improvement Project Selection, Management, and Monitoring and Staff Training Projects can be related to hospital acquired infections, patient safety, operations, care coordination, or care paths. A department gathers staff input to identify areas that need improvement and all staff, including nursing, are encouraged to provide input and feedback and expected to participate in order to reach goals. A Project Request Form is submitted and a QI Project Manager is assigned to help manage the project and details. Collaboration within and across teams and functions is fostered in order to align with the strategies of our organization to reach project goals. The QI team responds to requests for projects or data in a timely manner and support is provided through individual and team development, training ideas and opportunities, and team engagement. They ensure that quality-managed information technology systems are up and running to support user needs and propose an outline and agenda to effectively define, plan, implement, transition, monitor, and evaluate projects. Quality Methodology and Tools/Techniques and Communication to Staff When a project is started, there are meetings, in-person communication from the manager, and emails to ensure proper communication. This is an effective way of communicating because there is more than one type of communication. If you miss an email, you will hear about it in-person or in a meeting; if you miss a meeting, you will see an email or your manager will inform you. Goals, objectives, meeting dates and times, and team expectations are clearly reviewed and discussed. The project manager serves as a guide and resource, provides training ideas and materials, fosters consistency within and throughout the project, and provides an outline of what needs to be accomplished. If there is a significant list of goals, the team can be broken up into smaller teams that work on specific goals. Teams devise strategies to achieve goals and share with everyone at scheduled meetings what they are doing, their approach, and their progress with their particular tasks. If the project is fairly straightforward, the department can work together as one team. The tools/techniques and methodology work well and it has been effective to have a specific QI Project Manager involved to oversee projects because they provide clarity, direction, and tools, are supportive, they want you to improve, and they are a valuable resource on an ongoing basis. Evaluation of QI activities Evaluation of a project is ongoing. If a project has an estimated finish time of one year, regular meetings are established, typically monthly, to review progress, hear feedback, find out if objectives are clear, and if goals are attainable and being met. Meetings are also beneficial to address issues and concerns and find out if the team is working well together. If the process or a component is not working effectively, input is gathered, reassessment is done, and if needed, reorganization with new strategies. QI Initiatives in my Organization One initiative in our organization was to reduce restraint usage in the ICU.
The goal was chosen, background obtained, literature review done, methods established, and implications for nursing practice reviewed. They wanted to implement one-on-one discussions with bedside nurses related to behavioral justification for restraint use, use of least restrictive restraint, and prompt removal when clinically justified, along with coordination of information-sharing with nursing leadership to promote a data driven approach to reduction in restraint usage. Outcomes were that as a result of monthly discussions, there was a sustainability of reduction in usage of restraints in the adult ICU’s. Another initiative was the nurse driven urinary catheter removal protocol. The goals were to reduce catheter associated urinary tract infections through early removal of indwelling urinary catheters and increase compliance to the Surgical Care Improvement Measure Urinary Catheter Removal through a nurse driven protocol that standardizes care and sanctions catheter removal based on approved criteria. A pilot was conducted at two hospitals to assess efficacy of implementing the plan system wide. A plan was developed with interventions, a urinary catheter removal algorithm, and documentation compliance parameters. Outcomes were lower catheter days and reinsertion rates, decreased catheter utilization ratio, and infection rates
stabilized. In conclusion, health care organizations are accountable to provide quality care and utilize safe practices. Quality improvement initiatives help to continuously improve processes, practices, and performance in order to achieve the best possible outcomes for clients.
5), many hospitals in conjunction with the Joint Commission's 2012 National Patient Safety Goals has been rallying for hospitals to use evidenced-based practices (EBP) to the prevention of CAUTIs because evidence is growing showing that many are avoidable. Such practices such as utilizing a nurse-driven protocol to assess and evaluate the appropriateness and use of urethral catheter to determine how long a patient should have an indwelling catheter and when to discontinue it. Several factors have been identified that pose as risk factors to CAUTI which include but not limited to drainage bag not being below the level of the bladder, healthcare personnel not practicing standard precautions and utilizing aseptic techniques during insertion of catheters, unsterile equipment, and unnecessary placement of urinary
2013). Inappropriate use of urinary catheter in patients as stated by the CDC includes patients with incontinence, obtaining urine for culture, or other diagnostic tests when the patient can voluntarily void, and prolonged use after surgery without proper indications. Strategies used focused on initiating restrictions on catheter placement. Development of protocols that restrict catheter placement can serve as a constant reminder for providers about the correct use of catheters and provide alternatives to indwelling catheter use (Meddings et al. 2013). Alternatives to indwelling catheter includes condom catheter, or intermittent straight catheterization. One of the protocols used in this study are urinary retention protocols. This protocol integrates the use of a portable bladder ultrasound to verify urinary retention prior to catheterization. In addition, it recommends using intermittent catheterization to solve temporary issues rather than using indwelling catheters. Indwelling catheters are usually in for a longer period. As a result of that, patients are more at risk of developing infections. Use of portable bladder ultrasound will help to prevent unnecessary use of indwelling catheters; therefore, preventing
The last outcome, application of the quality improvement measures to improve health outcomes consistent with current professional knowledge throughout the nursing career was demonstrated through the Management and Leadership 4374 in the Optimizing Quality and Safety assignment which consisted of managing quality improvement initiatives through principles of patient safety. The Introduction to Evidence 4373 Critique Process assignment also demonstrated the seventh learned outcome, by applying evidence to clinical decision making improving patient safety and quality. The application of this evidence can be used in creating and updating policies and procedures in regards to patient safety and quality.
The purpose of this paper is to identify a quality safety issue. I will summarize the impact that this issue has on health care delivery. In addition, I will identify quality improvement strategies. Finally, I will share a plan to effectively implement this quality improvement strategy.
Nurses are pivotal in hospital efforts to improve quality because they are in the best position to affect the care patients receive during their hospitalization. Data collection and analysis is the core of quality improvement assisting in understanding how the system work, identifying potential areas in need for improvement, monitoring the effectiveness of change and outcome. Nurses are also the eyes and ears of the hospital to positively influence patient outcome. For example, nurses are the ones catching medication errors, falls, and identifying barriers to delivering care. In this nurse’s facility, in order to minimize patient falls the hospital implemented a falls risk assessment tool called, “The Humpty Dumpty Scale” upon admission
The value of nursing in promoting the high-quality patient care is enormous and precisely outlined in nursing-sensitive outcomes. Furthermore, the concept of clinical and administrative indicators is valuable to elaborate nursing care performance. The data of quality indicators is a comprehensive source of insights and guidance of the strategies in achieving the highest level of performance and satisfaction. The purpose of this assignment is to provide an analysis of data from the quality indicators dashboard and develop a nursing plan for areas that needed improvement.
The purpose of quality initiatives is to promote safe, timely, effective, efficient, equitable patient centered care( DeNisco & Barker, 2013). The quality improvement evaluation is important in the health care industry to find out the best practice care and to provide high quality cost effective care to patients. The public and private agencies are the regulatory entities in the health care Industry which promote quality and safety in the delivery of health care. The major regulatory agencies are CMS, the Joint commission, and AHRQ (deNisco & Barker, 2013).
Apply continuous technical and quality assurance resolution to patient/department complaints, ensuring departmental quality; project improvement, leading multidisciplinary teams, implementation of policies and systems.
An example of a quality improvement initiative that could be proposed would be to reduce medical errors by improving communication and teamwork. Medical errors usually occur when there is a breakdown in teamwork and communication. The first thing that I would propose is to have all medical staff members follow a routine daily round schedule. During the daily rounding, the teams will be encouraged to collaborate and discuss the patient plan of care. A performance improvement dashboard should be implemented. Medical staff should be encouraged to use the patient's bedside whiteboards to document and keep track of daily goals. Also, patients and family members should be encouraged to ask questions and collaborate on the plan of care.
THE NCQA health plan accreditation encompasses healthcare facilities to have written plan approved by the governing board and is required to be reviewed and updated periodically as if it was a policy or procedure document. Every department must have its own plan but not in any particular format. The plan must exhibit the essential aspects of the quality management system. This reading entails an example of a facility quality management plan. The board of trustees is responsible for the safety and quality care, treatment and services provided in the hospital. The board makes decisions with the medical staff and hospital management which include medical director, chief executive officer, nursing director, clinical services director, vice president
Quality improvement (QI) involves the regular and constant actions that enable measurable improvement in health care. QI results in enhanced health services, organizational efficiency, quality and safe care to patients, and desired health outcomes for individuals and patient populations (U. S. Department of Health and Human Service, 2011). A successful quality improvement program is patient-centered, a collaboration of teams, and uses data in systems. QI helps to develop a culture of excellence in nursing, identify and prioritize areas of improvement, promote communication and collaboration, collect and analyze data, and encourage continuous evaluation of systems and processes (American Academy
In health care, Continuous Quality Improvement (CQI) is defined as a structured organizational process for involving personnel in planning and executing a continuous flow of improvement to provide quality health care that meets or exceeds expectations. CQI is helpful in facilitating medical errors as its main focus is the organization’s system. CQI‘s main emphasis is avoiding personal blame. Its main focus is on managerial and professional processes associated with specific outcomes, that is the entire production system. The primary goals of CQI is to guide quality operations, ensure safe environment & high quality of services, meet external standards and regulations, and assist agency programs and services to meet annual goals & objectives. All stakeholders such as patients, employees, and so forth are involved in CQI.
It is essential to understand what CQI is in order to implement it correctly into practice. “Put simply, CQI is a philosophy that encourages all health care team members to continuously ask: “How are we doing?” and “Can we do it better?”
In order for a health care organization to gain trust and support it first must engage both external and internal stakeholders involved in the process. Effective continuous quality improvement takes into account the needs of administration, leadership, providers, and patients so that it may fully address the needs of each. In doing so organizations are establishing a partnership between each group that can lead to positive outcomes. According to Batson (2004) establishing partnership relationships promotes mutual respect, increases communication and collaboration, and helps to achieve organizational
In the 21st century, the Institute of Medicine (IOM) reported that many medical incidents have occurred by human error so they expressed to build a safer health system to reduce the error and provide the high quality of care to patients. Summed up the literature, quality defined that healthcare workers followed the current professional standards to apply in the patient care and prevention of unnecessary harm, and achieve patient’s expectations. IOM also identified that the concept of quality has included six key elements which are effective, timely, equitable, efficient, patient-centered and safe. Moreover, leadership has needed to monitor and manage the improvement process due to different of elements have affected the quality