Data Analysis and Quality Improvement Initiative Proposal

Quality improvement in healthcare is a fundamental aspect. Increasing the quality of healthcare improves patient outcomes with care. Moreover, it improves the satisfaction of healthcare providers such as nurses with the profession. Therefore, quality improvement innovations are crucial to guarantee high-quality care. Improved safety and quality of care is determined by a supportive working environment that promotes interprofessionalism, effective communication, evidence-based practices, and a strong leadership structure. Nurse practitioners have a significant role in the implementation of quality improvement initiatives. They commonly interact with patients and multidisciplinary teams, making them crucial in quality improvement initiatives. Nursing practitioners can also take leadership roles in healthcare settings. As leaders, they can work to improve and maintain quality in clinical and nursing departments. The paper will address the need for quality improvement initiatives in a healthcare setting known as TrueWill General Hospital. The healthcare setting has released dashboard metrics for the surgical department. The data include near misses and adverse events. The dashboard showed four quality indicators, including patients with pressure ulcers, pain levels of above seven on a scale of 1-10, patient readmission rates, and length of stay exceeding a week. The data from the dashboard can be used in developing evidence-based solutions to improve the quality of care.

Analysis of Dashboard Metrics

The surgical department admits patients with various surgical conditions. Services offered in surgical units include perioperative care. Patients in the surgical unit usually are in critical condition. Therefore the department is effective for a quality improvement initiative. Additionally, the unit has numerous multidisciplinary team members who work collaboratively to treat and manage patients. This includes nurses, nutritionists, pharmacists, social workers, rehabilitation therapists, physicians, and ancillary medical staff. The hospital dashboard addressed four areas of quality improvement. It includes the number of patients with pressure ulcers, pain levels of above 7 on a scale of 1-10, length of stay exceeding one week, and patient readmission rates. The data was collected from 2021 January 31 to 2022 February 1. The data collected are indicated in Table 1. The data revealed that the number of patients experiencing pain between 7 and 10 increased from twenty to 29. Similarly, the number of patients with pressure ulcers or bedsores increased from 15 in 2021 to 25 in 2022. There was a less significant increase in the number of individuals, with the length of hospital stays exceeding 7 days. Finally, the rate of patient readmission doubled.

Table 1

The data collected shows a need to implement a quality improvement initiative. The rate of pressure ulcers, the number of patients being readmitted, and patient readmission rates increased significantly. High-quality care should be efficient, equitable, patient-centered, reliable, effective, and safe (Sfantou et al., 2017). High rate of pain scores, pressure ulcers, and readmission signals the poor quality of care in the surgical unit. Pain is a quality indicator. Increasing pain scores in a healthcare setting indicate poor quality in pain management approaches. Increased length of stay is an indicator of poor quality of care. However, hospital stays can be increased by other factors such as hospital location, insurance type, injury severity, gender, and age. The length of the hospital can also affect the rate of hospital readmissions. The other causes of increased length of readmission include low patient engagement, ineffective follow-up and education on post-discharge instructions, medication noncompliance, and inadequate nutrition and medication errors. The common cause of readmission can include ineffective follow-up and health education in the surgical setting. Therefore, the healthcare setting should aim to reduce the rate of patient readmission by implementing evidence-based initiatives. The length of hospital stays and readmission has been associated with increased healthcare costs (Sud et al., 2017).

Finally, the rate of pressure ulcers in a healthcare setting can determine the quality of care. Pressure ulcers are associated with a lack of providing personalized care for patients. Pressure ulcers can also be associated with inadequate staffing and a lack of technology. Various technologies can be used to reduce the high rate of pressure ulcers. An example of the technologies includes the use of pressure-relieving devices. The diminished quality can affect the healthcare stakeholders in numerous ways. Firstly, it can lead to a reduced level of patient satisfaction. These can reduce the confidence of the patient in the hospital. Therefore, there will be a reduced number of the patient. A reduced number of patients can reduce the revenue and profit margin. The healthcare setting can also suffer numerous legal and ethical implications. A quality improvement initiative is needed to avoid such devastating effects.

Quality Initiative Proposal

Nurse practitioners should take leadership roles to improve the quality and safety of healthcare. Effective nursing leadership increases the likelihood of improved quality care for patients and clients. Change in healthcare is inevitable. The organization needs to implement change in healthcare to improve the quality of care. Change in leadership in the department will help lead the organization to change. Therefore, it will be crucial to enhance the quality and safety of patient care. Healthcare should strive to reduce pain, pressure ulcers, length of hospital stays, and readmission rates.

The organization’s mechanisms are ineffective due to poor quality care, evidenced by the dashboard data. Various initiatives can be implemented to improve the quality of care. However, success in implementation will depend on the leadership structures and the motivation of the healthcare providers. Readmission rates are increasing. Therefore, various evidence-based interventions can be implemented to reduce the rate of readmission. The evidence-based approaches I will implement include the utilization of post-discharge interventions to decrease the rate of hospitalizations. Pedersen et al. (2017) conducted a study to investigate the effectiveness of post-discharge interventions on patients. With chronic obstructive pulmonary disease. The researchers found out structured and planned post-discharge interventions such as health education and follow-up reduce the rate of 30-day hospital readmission. Therefore, the surgical setting can implement the intervention to reduce the surprisingly high readmission rate in a healthcare setting.

The cases of pressure ulcers have increased in the healthcare setting. Currently, the surgical unit has set a policy requiring 2 hourly repositioning of critically ill and patients with reduced mobility. Despite that, the rate of pressure ulcers has still risen. The evidence-based quality improvement approach I would recommend is utilizing pressure-relieving devices and technologies in conjunction with 2 hourly repositioning to reduce the rate of pressure ulcers. Kotner et al. (2018) conducted a critical review to investigate pressure ulcer prevention strategies. The researchers established that repositioning and the use of pressure-relieving devices such as alternating air pressure mattresses effectively reduce the rate of pressure ulcers. Therefore, the department can utilize the intervention to improve the quality of patient care. The healthcare practitioner should use an evidence-based tool to manage perioperative pain. The World Health Organization recommends the modified WHO ladder for managing pain. The ladder improves pain management among healthcare practitioners (Anekar et al., 2021). Finally, the length of hospital stays depends on the overall quality of care provided. Reducing medical errors, pressure ulcers, rate of nosocomial infections, pain, and patient falls are associated with reduced hospital stays and cost of healthcare. The department needs to use these quality measures to reduce the length of hospital stays.

Finally, the leadership structure should be changed. The organization should utilize a transformational leadership style. Transformational nursing leaders will encourage, motivate and inspire the employees to create and innovate change that will help improve the quality of care in the setting (Khattak et al., 2020). Motivation is key to implementing any change initiative in a healthcare setting. Leaders should enable the employees to meet and achieve the goals and objectives of the organization. Moreover, transformational leaders will inspire confidence, loyalty, and loyalty among healthcare providers. It will enable every individual to have a shared goal of improving the quality of the surgical unit. In nurses, transformational leadership will improve their morale, productivity, and job satisfaction. This translates to high-quality care in the surgical unit.

Model of Quality Improvement

The quality improvement model effective for implementing the evidence-based quality improvement interventions and transformational leadership is the Plan-Do-Study-Act (PDSA) model. It is also known as the model for improvement. The model will offer the organization a way of structuring improvement models. The model has four lifecycles that can be used for implementing a change initiative. The stages are planning, doing, studying, and acting.

1. Plan: Plan is the first stage. Various activities are implemented in this stage. Firstly, the organization will assemble a multidisciplinary team with insights into the opportunity or problem for improvement (Christoff et al., 2018). After recruiting the team, each member will be assigned roles. Moreover, the meeting schedule and timelines for the quality improvement initiative will be set. Secondly, the objective or aim of the quality improvement initiative will be established. The organization aims to improve quality by lowering the number of pressure ulcers, hospital readmissions, patients reporting pain scores of above seven, and reducing the length of hospital stays. The statement will also include an evaluation plan for the change initiative. The current practices will then be discussed and a problem statement drawn. Finally, the alternatives will be causes, and alternatives will be identified. These include utilizing evidence-based tools and initiatives. It will also include the implementation of transformational leadership to improve the quality of care.
2. Do: this is the second phase of the quality improvement model. In this step, a strategic plan will be created with the help of the interdisciplinary team members. The unit will then start implementing the action plan.
3. Study: the data collected in the previous stages will be analyzed. Here, the leaders will try to establish if the plan will improve the quality of care. The unintended side effects will also be identified. The leaders will then determine the action that is worth investing in.
4. Act: this is the final phase. The team will reflect on the outcomes and plan. They will determine if the plan resulted in a success and whether it should be implemented in the surgical unit. Some of the activities the team will implement in this phase include communicating accomplishments to external and internal stakeholders, taking steps to sustain the accomplishments, and making long-term for future quality improvements.

The model is effective in ensuring quality improvement. However, various factors may affect the quality improvement process. Firstly, the initiative focused on four indicators. Therefore, it will be challenging to analyze data and monitor success in the four areas of quality improvement. Other factors unrelated to the process and structure of care may be responsible for the diminishing quality. These may make it challenging to establish and discern whether the initiative was successful. Therefore, the organization should consider other patient-related factors and organizational factors such as volume, utilization, and mortality indicators during implementation. Finally, further evaluation should be done, including nurse-sensitive indicators and patient satisfaction. Nursing indicators such as workload, burnout, and staffing shortages can lead to poor quality and even affect the implementation of the quality improvement model.

Integrating Interprofessional Perspectives That Support Quality Improvement

The perspectives of the interprofessional team members are essential for improving the quality of care. Interprofessional teams in healthcare include doctors, nutritionists, physicians, therapists, financial managers, and nurses. These individuals have different experiences and expertise that may be useful in increasing the success of the quality improvement initiative. Therefore, healthcare professionals should promote a culture of interprofessional collaboration. The collaboration will improve problem-solving, cooperation, and the making of decisions to enhance the quality of care (Tomblin et al., 2019). As a leader, I will ensure every team member is involved. The second reason for integrating interprofessional team members in establishing the root causes of poor quality. Every healthcare professional may have a role to play in poor quality. For instance, when nurses do not follow the repositioning protocols, the rate of pressure ulcers can increase. Similarly, when physicians do not provide proper discharge instructions or are involved in medication errors, the causes of readmissions are likely to increase. Therefore, involving every member will provide insights into the reasons for poor quality. Feedback from these members can inform quality improvement initiatives. Finally, integrating the interprofessional perspective will minimize the potential for resistance to change (Mathieson et al., 2019). The involvement of stakeholders will motivate them and make them feel part of the change initiative. Therefore, involving multidisciplinary team members will reduce resistance to change.

Effective Communication Strategies to Promote Quality Improvement

Effective communication is essential for the success of the quality improvement initiative. Communication facilitates effective functioning in healthcare settings (Huber, 2017). Effective communication methods and tools should be used to relay the goals and objectives of the surgical unit. Effective communication strategies should be developed before implementing the quality improvement initiative. Communication will improve collaboration with the interprofessional team. Leaders should use effective communication strategies when involving multidisciplinary team members to enhance their cooperation. One strategy that can be used to improve communication is the teamSTEPPS. The strategy improves collaboration and communication relating to patient safety (Buljac-Samardzic et al., 2020). Moreover, the strategy allows the elimination of emotional charge and subjectivity. Therefore, it allows the interprofessional team members to work together in addressing various patients’ safety concerns. Finally, a communication tool that can be utilized is the SBAR communication model (Buljac-Samardzic et al., 2021). The tools can effectively communicate patient safety concerns to the multidisciplinary team members. The tool starts with the situation and background before making or communicating assessments and recommendations.

Conclusion

Healthcare organizations should improve the quality of care to enhance patient outcomes. The hospital dashboard data indicate the quality of care is reducing due to the increasing number of pressure ulcers, pain index, readmissions, and length of hospitalizations. The healthcare setting can utilize evidence-based approaches to improve the quality of care. Additionally, the transformational leadership approach should be used when facilitating change. Involving multidisciplinary members’ perspectives will reduce resistance and enhance the success of the quality improvement initiatives. Finally, healthcare practitioners should ensure effective communication strategies and tools are used to implement a quality improvement initiative.

References

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