Quality Improvement in Healthcare and Nursing
Learn How to Write a Quality Improvement Research Paper in Healthcare and Nursing
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Quality improvement (QI) can be defined as the effort to better patient outcomes, system performance, and professional development (Batalden & Davidoff, 2007).
The Institute of Medicine (IOM) has challenged professionals to improve healthcare quality, with quality described using the following six domains: safety, timeliness, effectiveness, efficiency, equity and patient-centeredness.
These quality aims provide a framework for focusing improvement efforts. The unrelenting engagement of all providers is required to transform healthcare.
APNs are well positioned to lead quality initiatives by virtue of their advanced knowledge and preparation.
To effectively lead quality improvement requires understanding that organizations are complex adaptive systems; dynamic, unpredictable, and are composed of moving parts.
Knowledge of theoretical underpinnings of change (theory explicating the phenomenon of human behavioral change) is foundational to successful improvement.
A wide variety of QI models, tools, and methods are available to guide the APN in facilitating improvement.
In his book, The Seven Habits of Highly Effective People, Stephen Covey reminds us to “begin with the end in mind”. Dr. Covey is talking about people’s personal quest for improvement.
However, wouldn’t the same apply to quality improvement matters? The question is rhetorical and the answer, of course, is “yes”. Before we decide what to do, we must decide where we are going.
If you have not determined where you are going, then how do you know when you have arrived, or how close you are to getting to your destination?
In quality improvement, we refer to our destination as outcome measures. Most outcome measures are downstream, meaning changes in outcomes are achieved over time and confounded by multiple variables.
Process measures are a means to an end. In other words, processes are the activities that affect the outcome measure.
For instance, if one wanted to improve patient satisfaction (an outcome measure) the variables affecting patient satisfaction would be examined.
One such variable may be the process of communication from the patient to the nurse for patient calls. Perhaps, the first thing the change agent would do is to assess the nurse response time to patient calls (process measure).
It may be important to correlate the response time to the hour of the day or the day of the week.
The investigator would look for variability (how wide the range) in response times and understand the more variability in the process, the more complex and the more unpredictable the outcome.
Standardization of processes decreases the variability of process outcomes and promotes the likeliness of improving downstream outcomes. Rev 5.21I suspect that you already understood all of this, right?
It makes perfect sense. Before we move forward, I want to emphasize a few essential points. First, when facilitating process improvement, it is essential to understand the complexity of a practice concern and theprocesses influencing outcomes.
We often use tools to help us understand the problem, such as a fishbone diagram, a flowchart, a root cause analysis, a failure mode effect analysis or othersimilar tools.
If one doesn’t take the time to understand the issue, improvement strategies, regardless of their evidence-base, do not have a chance of success.
Facilitating process improvement requires a “systems thinker”, one who focuses on the system and processes and not the person.
A systems thinker recognizes that to err is human, so he/she attempts to build safeguards into processes to reduce variability of outcomes.
Once serving as a legal nurse expert I reviewed a case where a nurse mistakenly gave four times the prescribed dose of digoxin.
Subsequently, the patient experienced a cardiac arrest and although revived suffered long term consequences. It is easy to look at a situation and criticize the nurse for the error.
Why everyone knows the toxicity of digoxin. How could anyone be so careless? A systems thinker looks differently at the error.
The system thinker looks for system breakdowns. For instance, why was this large dosage of digoxin available to the nurse?
What was the procedure for pharmacy to check physician orders for drugs before administration? Was there a nurse double check system in place to reduce nurse administration errors? If yes, was it being used?
If the double check policy was not being practiced, were there obstacles preventing use of this safeguard? Were alerts available to warn nurses against this dosage of medication?
In other words, where were the safeguards to protect against human error? What process failures contributed to the medication error?
Lastly, when selecting the process measures, consider the logistics and difficulty of data collection.
Nursing occurs in real time with real people. Human resources are limited. Asking nurses to do one more thing will probably get someone tarred and feathered.
Look for measurements already in place so data can be easily obtained. Rev 5.21Rev 5.21
Assignment Instructions: For this assignment select a practice improvement issue within your organizational system and within the realm of your practice area.
Using the grading rubric as a guide, develop a quality improvement plan to address the identified issue.
The purpose of this paper is to demonstrate knowledge of the essential elements of quality improvement, with change theory as an underpinning for the process.
Do not use a quality intervention plan that has already been implemented for this assignment; this should be a new plan for the organization with a clear measurable problem statement and a planned evidence-based intervention.
Students are not expected to implement the plan; however, the process for implementation and evaluation is addressed as part of the planning process.
The paper should be carefully written in a formal style, based on primary sources, provide an integration of ideas, and be 6 to 7 pages in length, excluding title page, appendices & reference list.
Organized flow, logical progression of ideas, and clarity in thought are essential.
Please use headings consistent with the topic areas of the rubric to separate content.
References must be timely; published within the previous five (5) years. Liberal number of primary and peer reviewed references (minimum of 10).
This paper will be automatically submitted to Turnitin when you submit your assignment.
You will be allowed to view the Turnitin report and resubmit the paper until the due date.
Any papers submitted OR resubmitted after the due date will have a late penalty applied consistent with the syllabus unless prior arrangements were approved by the primary faculty. Scholarship
Expectations: The assignment will be formatted based on the APA 7th edition.
There will be a title page and headings used appropriately. Clarity and conciseness in writing, grammar and spelling will be consistent with graduate level work.
The points allocated for scholarship will be at the discretion of the faculty member. You are clinical nurse scholars in the making.
You are the nurses with advanced education/ DNPs and members of the highly literate profession of advanced practice nursing who will chart the future of health care.
Good writing ability is as much a required skill for nurses in advanced practice as performing clinical functions. Therefore, precision and scholarship is expected in all assignments.Rev 5.21
Grading Rubric Name: Grade Points Introduction paragraph (one paragraph).
Introduce a practice issue appropriate for a quality improvement project facilitated by a MSN or DNP prepared nurse. The practice issue should be stated as a clear problem statement.
There must be a thesis statement at the end of the paragraph that tells the reader the purpose of paper and what will be discussed.
1 Describe background/context of the identified local measurable practice issue. Quantify (measure) the local practice concern (the local problem) to establish a baseline for your work.
State the problem in one measurable sentence. State a project aim in a single sentence.
Use evidence to further support the problem/concern. Note: Do not describe the intervention in this section. The next steps will focus solely on the problem.
Discuss and apply one theoretical underpinning of change (Lewin, Rogers, Kotter, Havelock, Prochaska & Diclemente, Bandura) for the proposed quality initiative.
Using the selected change theory, describe the profound importance of staff engagement, empowerment, commitment, and ownership of practice improvement initiatives/projects.
2 Describe how at least one improvement tool (root cause analysis, fishbone cause and effect diagram, FMEA, etc.) can be used to better understand your identified practice issue.
Describe how to apply the tool to the identified practice issue to understand and assess the concern before planning an intervention.
Do not describe the solution, describe how you will investigate the problem using this tool.
3 Select a model (e.g., PDSA, FADE, Six Sigma, TCAB, TeamSTEPPs) for the quality improvement project.
Describe the model and summarize the practice improvement initiative/intervention(s) using the steps of the model.
This is the point in the paper where you describe the evidence based intervention (with citation) based on the problem, background and investigation of the concern.
3 Budget: Discuss briefly the revenue or savings associated with the project, expenses and identify if there will be a return on the investment.
Use the budget template provided with the assignment link to prepare a brief budget. 10.22.20
Clarification: Do not attach the budget template to the paper 2 Based on Donabedian’s work, identify and describe
(a) the structure measures,
(b) the process measures, and
(c) the outcomes measures for the quality improvement intervention(s) for this project.
3 What qualitative and quantitative measures will be identified to determine effectiveness of quality initiative?
How would qualitative findings contribute to the evaluation of your specific quality initiative?
3 Identify and briefly describe at least two visual displays for reporting outcome data for your selected practice issue (e.g. histogram, run chart, pie chart, bar graph, etc.). 1.5
Conclusions: Summarize the essential points of paper (one paragraph). 1Rev 5.21 Scholarship:
The assignment will be submitted consistent with the Assignment Instructions described in this document. Deduction Comments: TOTAL 0 25 2.
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