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Importance of quality improvement
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Quality improvement implementation
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Data Analysis and Quality Improvement Initiative Proposal The health care industry is charged with continually pursuing different ways to improve patient safety and quality. We see this in the Triple Aim initiative of optimizing the performance of heath care. The Institute for Healthcare Improvement (IHI) seeks to improve three dimension of care. First, IHI wants to improve the experience of patients under care. Second, improve overall population health. Third, reduce healthcare cost. When the Triple Aim was developed, no health care provider or organization was accountable to the three dimension of health care. The Triple Aim promotes to change this (Institute of Healthcare Improvement, n.d.). The steadfast commitment to both quality and safe cares thrusts healthcare providers to think of initiatives on improving monitoring and adherence to treatment policies in order to improve outcome. This paper will analyze a healthcare issue identified. It will discuss a proposed quality improvement initiative. It will review the data that supports the issue. It will examine the different interprofessional perspectives taken …show more content…
into consideration that led to the proposed initiative. In addition, it will demonstrate effective communication strategies that promote the quality improvement initiatives within the members of the interprofessional team. Data Analyzed for Health Care Issue/Concern Vila Health is an organization that provides hospice care to patients at home. Home health nurses visits the patients at their home intermittently. Vila Health has been gathering monthly data about hospice adverse events and near misses for 2014 and 2015 calendar year. These events have exposed the patient to harm or potential harm. Gathering data is the first step in data analysis. Ghazisaeidi, Safdari, Torabi, Mirzaee, Farzi, and Goodini (2015) discuss how measuring performance or patient outcome must first start with baseline data. This data will display opportunities for a quality improvement initiative. Additional information was also extracted from interviews conducted with stakeholders of Vila Health. The first interview was with the Owen Welch, Chief Financial Officer who advises that nurses are equipped with secure laptops with remote access to electronic health record (EHR). The company is also considering venturing into video conferencing as a means to improve care that the patient receives on site by enabling different or covering physicians to engage with the patient while the nurse is visiting. The company is also looking into technology that alerts hospice nurses when the patient requires added care. In addition, Owen Welch mentions that a hospice offsite program such as this does face nurse staffing issues when the nurses are stretched too thin while travelling to the home of the patient. Another issue is when the nurses feel like the census is too high and they are not able to provide the quality care the patient needs. The second interview was with Roger Goldberg, Director of Hospice Services. Roger Goldberg provides insight on the mission of the hospice program, which is to provide comfort care and treat the patient symptoms. The patient and the family are the beneficiaries of care. The third inter view was with Jackie Sandoval, Chief Nursing Officer. Jackie Sandoval talks about the team members of the interdisciplinary team, which includes nurses, physician, social worker, coordinator, and chaplain. Jackie further advises that patients are referred too late to the hospice program. Hence not being able to obtain all the benefits that the program provides. The last interview is with David Brooks, Quality Assurance Director who discusses about the available company policies and procedures in place for falls risk patients, for maintaining sanitation, management of medical waste, and for appropriate storage of medications. In addition, David Brooks talks about their policy on pain assessment and escalated symptoms that may require inpatient admission. The adverse event data that was collected by Vila Health showed that the highest adverse event for both 2014 and 2015 was for patient with less than 7 days length of stay. Followed by inpatient admission. The third highest ranking is pain level of 7-10 more than 24 hours and the last area of adverse event is inadequate symptom relief more than 24 hours (Vila Health: Data Analysis, n.d.). QI Initiative Proposal Based on Issue and Supporting Data Analysis The Vila Health data shows the highest adverse event occurring in the category of less than seven days length of stay. There are also adverse events occurring with regards to the patient’s pain level and inadequate symptom relief for more than 24 hours. Jackie Sandoval, the Chief Nursing Officer advises that the patients are referred too late to the hospice program. Vila health also has policies that address pain and other symptoms that may require an inpatient admission. There are two opportunities for quality improvement for Vila Health. First, patients need to be referred to Vila Health earlier. Second, improve pain and symptom relief. Currow, Allingham, Yates, Johnson, Clark, and Eager (2015), conducted an analysis on improving hospice palliative care and assessing outcomes of the initiative. The analysis included three elements: (a) the purpose of the initiative, (b) data gathered to establish baseline, and (c) results data. The purpose was to improve hospice services using defined patient outcomes. The Australian Palliative Care Outcomes Collaboration targets the outcomes and reviews whether the outcomes validate effective improvement. Data collected includes analyzing the patient’s clinical phase. Is the patient terminal, deteriorating, unstable or stable? Furthermore, the Symptom Assessment Scale and Palliative Care Problem Severity Score was utilized to assess patient’s symptom. The study also collected point-of-care data between the dates of July-December 2008 and afterwards compared this to baseline in six 6-month reporting cycles for services rendered. Results data analysis to show improvement of the initiative. There are different quality improvement methods; one method is called the Plan-Do-Check-Act (PDCA) also called the Shewhart Cycle. The PDCA demonstrates the four essential steps of a quality improvement plan. First, find out what the issue are and come up with solutions. Second, implement changes on a smaller scale first to minimize work disruption. Third, check the quality of the output is after implementation. Finally, if the outcome is successful, act to implement on a larger scale (Kader, Eckert, & Toth, 2015). Development of the quality initiative for Vila Health includes reviewing the purpose of the quality improvement (QI) plan.
The purpose is to reduce the adverse events or near miss events. The next step is to look at the data that needs to support the quality improvement plan. Challenges within the Vila Health hospice program include delayed referral to the hospice program, lack of resources or nursing staff that visits the patients in the home, inadequate policy for pain assessment, and late assessment of patient symptoms. The baseline data of the challenges will serve as the starting point of the quality initiative. Afterwards, place measures that confirm patient needs and outcome are being met. Peer collaboration and service is required in order to contribute to the benchmarking, enhance models of care, and improve patient outcome (Currow et al,
2015). The quality improvement initiative proposal must include improvement plan for all identified challenges. Staffing assessment is essential to the plan. It should be based on the work and time the nurses take to travel, assess, and care for the patient and travel time to the next patient. Enhance the patient visit by accessing video capable equipment so that patients can have real-time physician assessment. Upgrade the technology tools to enable the patient to talk to a nurse when symptoms flare up. Develop a physician education program on the patient referral process in order to avoid delay in referral and patient not benefitting to all that the hospice program has to offer. Re-visit the current policies and procedures to assess pain symptoms. Interprofessional Perspectives in Leading QI Proposal High quality patient care is achieved when there is efficient interprofessional teamwork. When there is inept or separated teamwork, results may prove to be suboptimal. The interprofessional team members need to work together to give the patient a comprehensive care. (Scaria, 2016). According to Sommerfeldt (2013), it is important for nurses to articulate their role in the practice setting. The nurses have the ability to clearly communicate their thoughts to other members of the interprofessional team. The nurses visiting the patient in their homes will need to report to the Vila Health administration if they are spread too thin by having a high census per nurse. The interprofessional team must meet daily to discuss the patients seen that day so that any symptoms that patients have can be addressed the same day. The Director of the hospice program can schedule a standing meeting at a specific time of the day where all the members of the interprofessional team can participate is critical to the success of the QI plan. A member of the quality team can take the lead on facilitation of the initiative. The visiting nurses are responsible for collecting data and measuring outcomes. If the QI plan is successful, it will reduce the adverse events. It will improve the nurses’ quality of care, as they will not have a high patient census. The patient will receive real-time physician visit as needed and they will receive the appropriate care for their current symptoms. Effective Communication Strategies to Promote QI with Interprofessionals Communication is critical in the success of a quality improvement initiative. Poor communication across the interprofessional team can lead to adverse event for the patient. Vila Health’s current adverse event includes pain level of more than 7-10 for more than 24 hours and inadequate symptom relief. Communication relayed by the patient to the nurse and from the nurse to the physician must be clear and concise so that effective symptom management can be ordered. One communication tool has been recommended to improve patient quality and safety. The Situation- Background-Assessment-Recommendation/Request (SBAR) communication tool is a structured tool that is used in a variety of settings to improve teamwork and to ultimately improve the care delivered to the patient. The SBAR requires the team communication to include the situation, the problem, background, current relevant information that is related with the situation, assessment of the patient, and recommendation. The SBAR format permits for a standard expectation of the content and arrangement of the information (Kostoff, Burkhardt, Winter, & Shrader, 2016). It also standardizes reporting from one team member of the interprofessional team to the next. Conclusion Healthcare organizations and health care professionals must contribute to realize the triple aim goal. Adverse events or near misses should be eliminated from patient care. This paper discussed a healthcare issue, a quality improvement initiative proposal, interprofessional perspectives, and effective communication tool that can be used to standardize reporting structure to ultimately improve the quality and safety of patient care.
According to the Institute for Healthcare Improvement’s article “A Primer on Defining the Triple Aim”, the Triple Aim was introduced as a framework as opposed to a concept. Frameworks are structures derived from a series of related concepts; in this case: patient experience, cost of care, and population health. Comparatively, William Kissick’s Iron
The Texas Medical Institute of Technology, through programs such as Chasing Zero, is bringing a public voice to the issue of healthcare harm. The documentary is a stirring example of the quality issues facing the healthcare system. In 2003, the NQF first introduced the 30 Safe Practices for Better Healthcare, which it hoped all hospitals would adopt (National Quality Forum, 2010). Today the list has grown to 34, yet the number of preventable healthcare harm events continues to rise. The lack of standardization and mandates which require the reporting of events contributes to the absence of meaningful improvement. Perhaps through initiatives such as those developed by TMIT and the vivid and arresting patient stories such as Chasing Zero, change will soon be at hand.
A powerful speech given by Don Berwick on December 2004 explains ways in which healthcare industries needs to implement in order to save lives and to reduce the mortality death rates that occur in the healthcare (i.e. no needless death). In his speech entitled “Some Is Not A Number…. Soon Is Not A Time” invites all healthcare care organization U.S. and the world to come together to save 100,000 lives by June 14th 2006 at 9am exactly 18 months from the day of the speech. In order to achieve this goal Dr. Berwick suggests there should be a high standards protocol that will help improve care and reduce patients harm.
National Institute for Health and Care Excellence (NICE) developed the area of their concern for quality improvement in relation to t prevention and treatment of various kinds of health conditions or services. Therefore, in the course of this innovation, team members will make sure patients are safe and not harm by the change that aims to help them; care is effective, practising with the best available evidence based practice, is person centred; making patients first concerned when making clinical decision; avoiding unnecessary delays and provide care in timely manner (Health Foundation, 2013).
The standards of the Joint Commission are a foundation for an objective evaluation process the may help healthcare organizations measure, assess and improve performance. These standards are focused on organizational functions that are key for providing safe high quality care services. The Joint Commission’s standards set goal expectations of reasonable, achievable and surveyable performance of an organization. Only new standards that are relative to patient safety or care quality, have positive impact on healthcare outcomes, and can be accurately measured are added. Input from healthcare professionals, providers, experts, consumers and government agencies develop these standards.
With healthcare costs soaring in the United States, there is a continuous movement by hospitals and health systems towards reaching a number of patient and system oriented goals related to higher levels of quality, safety, and cost effectiveness. The Triple Aim captures the essential challenges and opportunities of this time within the U.S. Healthcare system. Formally introduce by the Institute for Healthcare Improvement (IHI) in October 2007, the Triple Aim is theoretical model for optimizing health system performance. The initiative has three components: improving the patient experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita costs of health care (Berwick,
October of 2007 The Triple Aim Initiative was launched by the Institute for Healthcare Improvement (IHI). It was created to lower the rate of increase in the per capital cost of care and also to help health care organizations better the health of a populations patients experience of care (McCarthy & Klein, 2010). In order to improve the experience of care they had to improve the quality, access, and reliability that the patients receive.
Thus, it is imperative that evidence-based practice is conducted to provide the best current, valid and reliable evidence in an aim to close the gap between non-conformity and coincide with the professional obligation of providing the patient with the best possible care (Liamputtong, 2013).... ... middle of paper ... ... Patient safety and quality of care. Rockville, MD: Agency For Healthcare Research And Quality, U.S. Dept. of Health.
An important topic is being discussed and it concerns hospice care. Hospice care is patient/family centered program which provides compassionate, professional, state-of-the-art physical, emotional, and spiritual care and support for people facing life-limiting illnesses. Indeed, there are many opinions about hospice care. However, by most measures of benefit and cost, hospice has been a successful experiment in end-of life care (Lessons from the Hospice Benefit, 2017, Pg. 58). As a result, I believe that hospice care is very beneficial to society.
Healthcare around the world is constantly changing and improvement in quality of care is pursued. Quality assurance is vital to healthcare. According to the American Society for Quality [ASQ], quality assurance is “the planned and systematic activities implemented in a quality system so that quality requirements for a product or service will be fulfilled” (n.d). In other words, once an issue in a system is identified, quality assurance involves the implementation of activities to fix the issue and meet the required standards. The short video “Quality improvement and healthcare reform: Patient experience with David Feinberg” depicts the journey of a UCLA hospital in identifying issues in its health
Continuous quality improvement is engrained in the culture of all successful healthcare organizations. As future healthcare administrators, it is imperative that we create an atmosphere that ensures quality is delivered to the patient though the care provided under an organization management. While there are many measures that help define quality in healthcare organization, ongoing consistency, reliability, and most importantly accountability are characteristics of an administration that has created a culture of excellence for their patience and staff alike (Joshi, Ransom, Nash, & Ransom, 2014).
Understanding quality measurement is essential in improving quality. Teams need to be able to understand whether the changes being made are actually leading to improved care and improved outcomes. For data to have an impact on an improvement initiative, providers and staff must understand it, trust it, and use it. Health care organization must understand the measurement of quality provided by the Institute of Medicine (patient outcomes, patient satisfaction, compliance, efficiency, safe, timely, patient centered, and equitable. An organization cannot improve its performance if it does not know how it is performing. Measuring quality improvements is essential as it reflects the quality of care given by the providers and that by comparing performance
...d procedures are now being monitored to improve clinical processes. Ensuring that these processes are implemented in a timely, effective manner can also improve the quality of care given to patients. Management of the processes ensures accountability of the effectiveness of care, which, as mentioned earlier, improves outcomes. Lastly, providing reimbursements based on the quality of care and not the quantity also decreases the “wasting” and overuse of supplies. Providers previously felt the need to do more than necessary to meet a certain quota based on a quantity of supplies or other interventions used. Changing this goal can significantly decrease the cost of care due to using on the supplies necessary to provide effective, high-quality care. I look forward to this implementation of change and hope to see others encouraging an increase in high-quality healthcare.
Quality improvement is a formal process to examine and improve performance through the analysis of data. The primary goal of quality improvement is to enhance patients’
Interventions that are practiced with an evidence-based standard is definition behind the mission of quality and cost of health care. The final component of the triple aim asserts a value be added to the care of individuals. By utilizing evidence-based practices managed care produces best outcomes for the scenarios in the most cost effective manner. “ In effect, patients, caregivers, organizations, and managers would know the “state of the system” with respect to its reliability, adherence to evidence, cost, and progress in improvement,” (Berwick, 2013, p. 1922)