NUR2101 Chronic Care Across The Lifespan A

Develop a concrete plan to improve the score of the question you selected for change. Make sure to include:

Why these indicators are important to hospitals/agencies – i.e. operations, finances, quality, safety. Discuss these questions with your unit leadership.
Why you selected the specific question. Include the score for the question you chose. Did you identify a gap in practice that needs improvement and could improve the score?
The specific steps in the plan you develop must include:
The proposed interventions and timeline for implementation of the interventions,
Time frame for measurement of results, be specific. Must be related to the metrics you would use to measure success of your plan
A brief description of any tools you identify that are to be used in the proposed plan and implementation,
How you will “promote” the plan to your manager and co-workers to gain support for the project
Your paper should reflect your synthesis of the literature you find with appropriate references to support your plan. This will involve investigating patient hospital experience literature and process improvement content and methods. 

Introduction

Quality improvement is a systematic approach in healthcare industry that allows any organization to increase the efficiency of their services to a sustainable, satisfactory and profitable level. The process of improvement often consists of several essential phase namely gap analysis; implement theory of knowledge, development planning, implement changes, monitoring and evaluation (Kaplan et al., 2012). The aims of any improvement in healthcare service are safe structure to avoid any injuries of patients, Timing that ensures the punctuality of the process, Effectiveness that provides more stable outcomes, Efficiency for sustainable development, Equitability to ensure unbiased service providing and Patient Cantered approach to prioritize patient’s perspectives.  

In this paper the healthcare service provided by the organization named Aventura Hospital and Medical Centre will be assessed to find the scope for improvement. For this the service quality will be compared with other state level organizations and regional as well as national average records. For this comparing the chosen organizations are Bartow Regional Medical Center and Bethesda Hospital East. All these three institutes are situated in the state of Florida. In this paper the development plan will be also developed with the discussion of implementation process. Furthermore, the strategy to develop adequate support and promotional scope for this improvement will be discussed.

Essentiality of Rate of readmission

Returning to the hospital after discharging the patient from the hospital as an unplanned care disrupts the regular life and wellbeing of the patients. This type of repeated readmission also increases the risk of harmful events such as healthcare associate infection. Apart from that this repeated procedure also cost extra money from the patients and extra energy from the healthcare workforce (Al-Abri & Al-Balushi, 2014). The rate of readmission also directly emphasize the quality of the healthcare system and the communication level with patient care integrity. In some cases after reappearing the symptoms of treated problems the patients go to another healthcare organization for having better experience. In these cases, the healthcare organization even does not have proper records of rate of readmission for the patients with COPD, Heart issue, Pneumonia, Stroke, CABG surgery, hip or knee replacement and other issues (Unützer et al., 2012). Many healthcare measures can be utilized to monitor and keep records of the rate of readmission for patient after discharge from the healthcare facilities. In most of the hospitals and healthcare organizations the returning of the patients within 30 days after previous discharge are counted. Apart from that for chronic diseases the rate of readmission also helps the healthcare professionals to formulate the existing condition of patients and to find their potential immunity.

Gap in healthcare practice

After comparing the records of chosen three healthcare organizations namely Aventura Hospital and Medical Centre, Bartow Regional Medical Center and Bethesda Hospital East it has been found that in Aventura Hospital the rate of readmission is higher than the other two competitors. In this hospital the rate of readmission after discharge from hospital is worse than the national rate (13%) (medicare.gov., 2018). At the same time, where Bethesda Hospital East has lower rate in after hi[ or knee replacement, Aventura Hospital remains at the national rate of readmission ration for this orthopedic procedure. In colonoscopy Bartow Regional Medical has very low rate of readmission, however Aventura Hospital remains same to the national rate in this case as well. In case of Heart attack, hospital return days for heart attack patients is higher than the average rate for 100 discharge in Aventura Hospital. However, both of competitors show some promising report in this scenario. In case of Hear failure the  rate of readmission is worse than the national rate and hospital return days are higher than the average (ihi.org., 2018). In this measure Aventura shows very poor performance issue. Similar poor performance of this hospital can be found in case of Pneumonia patient as well.

Therefore from the fishbone analysis it has been found that the major dispute of the healthcare system in Aventura Hospital is its poor patient discharge management plan. Due to lack of training of healthcare stuffs for improving their capabilities to make effective discharge management plan, the patients are unable to maintain a post treatment guideline for a sustainable health (Kripalani et al., 2014). Along with that, the patients reviews also suggest that this hospital has a poor communication system that reduce the potentiality of patient engagement through communicational and emotional interaction.  

Development plan

In order to improve the existing situation Aventura Hospital has to develop appropriate discharge management system. The aim of this development plan is to develop a effective and sustainable discharge management practice that can reduce the rate or readmission significantly

Requirements

The following requirements will needed for the holistic development of effecting discharge management system:

Activity	Reason	Deadline
Developing a post discharge checklist	Supporting the caregiver to execute necessary activities required for discharge management	Next 1 moth
Training and development	Improving the communication skill of stuff and also increasing patient engagement	Next 6 months
Developing post discharge monitoring plan	To monitor if the patient is maintaining proper healthy procedure regularly during the recovery time in home	Next 3 months
Calling patient in every 5 days for next 2 months after discharge	Keeping track of home recovery update of patients	Next 1 months
Providing appropriate chart to the patient during the discharge from the hospital explaining	To provide all the necessary measures during home recovery phase	Next 4 months

Stakeholders and responsibilities

Stakeholder	Responsibilities
Human Resource management	Providing training to the healthcare stuffs regarding discharge management plan
Caregivers and healthcare professionals	Maintaining the newly imposed discharge management system according to the guidance
Patients	Showing cooperative attitude with the caregivers through maintaining the home recovery guidelines appropriately
Consumer communication	Maintain strong communication with the patients and developing records as per the patients feedbacks

Throughout the development phase all stakeholders should maintain a cooperative and collaborative relationship with each other to maintain the workflow and information interiority within the team. Apart from that, effective monitoring system is also essential to ensure the compliance of medical and non medical workforce (Nguyen et al., 2018). The organization should also develop an appropriate financial plan to implement all this activities for discharge management system.

Implementation and control

After planning the activities for new patient discharge management system appropriate control management will be highly essential.  In this phase the management has to identify an appropriate measurement system to control the workflow towards the most efficiency. Many control methods are available for the measuring system including Run Chart and control chart, Histogram, Pareto chart and scatter plot. In this implementation the management has to measure the success rate by measuring the rate of readmission of the patients within the next 30 days after receiving the discharge paper from the Hospital Authority (Dixon-Woods, McNicol & Martin, 2012). Therefore, in this case the measurement system has to handle a continuous measurement system to control the implementation effectiveness. Therefore the most effective control method will be the Run and Control chart.

In Run control char the management has to keep the record of each discharge and the readmission of the patients. Therefore in this control char the X axis will imply the period of reviewing records and the Y axis will imply the number of patient readmission within next 30 days after the executing the imposed discharge management process. The figure 2 will be a perfect example of control chart of sampling.

In Figure 2 the UCL means the Upper Control Limit and LCL means the lower control limit. The Upper control Limit is the boundary of maximum number of cases of readmission on a particular month. For a particular rate of readmission P, the target of the management will be make the value (UTL-p) positive and as high as possible (Gopichandran & Chetlapalli, 2013). On the other hand, target of the management will be make the value (UTL-p) positive and as high as possible target of the management will be make the value (P-UCL) negative or as low as possible. In this case the LCL is 2 and the UPL is 7. As per the graph, in 4^th month the number of total number of readmission is 8 which is higher than the UPL. Therefore in next month the target of the management would be to decrease the rate under the UPL which is 7.

Promotion and gaining support

In any organization imposing new strategy or operational strategy requires minimization of resisting force. These resisting forces usually come from workforce and existing work practice. Therefore, the management of Aventura Hospital has utilize following strategies to gain support and cooperation from the workforce.

Making vision

At the initial phase of the implementation new changes the leaders of various working groups have to generate the sense of urgency through establishing the reason behind the new changes. Creating the vision and promoting the vision within the workforce trough effective communication can also increase the acceptability of the excising workforce (Ettorchi-Tardy, Levif & Michel, 2012).

Effective communication

Communication is the key of any change management plan where all the stuffs can maintain a integrity and healthy relationship through friendly and cooperative relationship. In order to ensure the effective communication the management of Aventura Hospital should also develop and effective communication plan and all the necessary arrangement.  

Shared value

Sharing value is another essential aspect of the support development process. By sharing value the workforce of any organization can grow collectively with collaborative interaction within various departments (Dixon-Woods, McNicol & Martin, 2012). Sharing value also implies an ethic that says every stuff of a organization should share their knowledge and experience with the team member to help them developing effective mitigation plan.

Short term accomplishment

Human mind can focus more on short time goal consistently than a long time achievement with lengthy procedures. Therefore, creating short time accomplishment by effective benchmarking system will allow the healthcare workforce to be motivated (Gopichandran & Chetlapalli, 2013). After each achievement the workers can focus on the next short time achievement with more dedication.  

Conclusion:

From the above discussion it can be said that, quality improvement is a systematic approach in healthcare industry that allows any organization to increase the efficiency of their services to a sustainable, satisfactory and profitable level. It has been also found that returning to the hospital after discharging the patient from the hospital as an unplanned care disrupts the regular life and wellbeing of the patients. According the to record analysis and comparison it has been found that the major dispute of the healthcare system in Aventura Hospital is its poor patient discharge management plan. Due to lack of training of healthcare stuffs for improving their capabilities to make effective discharge management plan, the patients are unable to maintain a post treatment guideline for a sustainable health.

From the performance improvement development plan it can be concluded that throughout the development phase all stakeholders should maintain a cooperative and collaborative relationship with each other to maintain the workflow and information interiority within the team. It has been found that, in implementation phase, through Run control char the management has to keep the record of each discharge and the readmission of the patients. Making vision, effective communication, Sharing value and Short time accomplishment are the most effective strategy to gain the support from the healthcare workforce. 

Reference

Al-Abri, R., & Al-Balushi, A. (2014). Patient satisfaction survey as a tool towards quality improvement. Oman medical journal, 29(1), 3. doi: 10.5001/omj.2014.02

Dixon-Woods, M., McNicol, S., & Martin, G. (2012). Ten challenges in improving quality in healthcare: lessons from the Health Foundation’s programme evaluations and relevant literature. BMJ Qual Saf, bmjqs-2011., doi: 10.1136/bmjqs-2011-000760

Ettorchi-Tardy, A., Levif, M., & Michel, P. (2012). Benchmarking: a method for continuous quality improvement in health. Healthcare policy, 7(4), e101. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3359088/

Gopichandran, V., & Chetlapalli, S. K. (2013). Factors influencing trust in doctors: a community segmentation strategy for quality improvement in healthcare. BMJ open, 3(12), e004115.

ihi.org. (2018). Tools. Retrieved from https://www.ihi.org/resources/Pages/Tools/default.aspx

Kaplan, H. C., Provost, L. P., Froehle, C. M., & Margolis, P. A. (2012). The Model for Understanding Success in Quality (MUSIQ): building a theory of context in healthcare quality improvement. BMJ Qual Saf, 21(1), 13-20., doi: 10.1136/bmjqs-2011-000010

Kripalani, S., Theobald, C. N., Anctil, B., & Vasilevskis, E. E. (2014). Reducing hospital readmission rates: current strategies and future directions. Annual review of medicine, 65, 471-485. doi: 10.1146/annurev-med-022613-090415

medicare.gov. (2018). Medicare Hospital Comparison. Retrieved from https://www.medicare.gov/hospitalcompare/compare.html#cmprTab=1&cmprID=100131%2C100121%2C100002&cmprDist=0.0%2C0.0%2C0.0&stsltd=FL&dist=25&lat=0&lng=0&state=FL

Nadeem, E., Olin, S. S., Hill, L. C., Hoagwood, K. E., & Horwitz, S. M. (2013). Understanding the components of quality improvement collaboratives: a systematic literature review. The Milbank Quarterly, 91(2), 354-394. doi: 10.5001/omj.2014.02

Nguyen, J. T., Vakil, K., Adabag, S., Westanmo, A., Madlon-Kay, R., Ishani, A., … & McFalls, E. O. (2018). Hospital Readmission Rates Following AMI: Potential Interventions to Improve Efficiency. Southern medical journal, 111(2), 93-97. doi: 10.1136/bmjopen-2013-004115

Unützer, J., Chan, Y. F., Hafer, E., Knaster, J., Shields, A., Powers, D., & Veith, R. C. (2012). Quality improvement with pay-for-performance incentives in integrated behavioral health care. American Journal of Public Health, 102(6), e41-e45., doi: 10.2105/AJPH.2011.300555