Week 8: The Application of Quality Improvement Models in Organizations and Systems
The meta-analysis of eight studies of inpatient deaths, published in the Journal of General Internal Medicine, puts the number of preventable deaths at just over 22,000 a year in the United States, instead of the oft-cited 44,000-98,000 estimate of a landmark 1999 study by the Institute of Medicine. Other frequently cited studies have placed the number of deaths as high as 250,000 deaths per year, which would make medical error the third leading cause of death, behind cancer and cardiovascular disease.
—Hathaway, 2020
These statistics indicate the need for quality improvement as it relates to patient safety. As you have examined throughout this course, error is a part of the human experience; however, when you are a healthcare professional, these errors can often be matters of life or death. What can an organization do to minimize these errors? Why is it important to consider potential errors in the application of quality improvement?
This week, you will examine the application of quality improvement through specific models. You will explore and justify how these models may be used to best address adverse events in nursing practice.
Resource:
Hathaway, B. (2020, January 28). Estimates of preventable hospital deaths are too high, new study shows. YaleNews. https://news.yale.edu/2020/01/28/estimates-preventable-hospital-deaths-are-too-high-new-study-shows
Learning Objectives
Students will:
Analyze quality improvement models
Analyze adverse events requiring quality improvement
Justify application of quality improvement models related to adverse events in nursing practice
Learning Resources
Required Readings (click to expand/reduce)
Required Media (click to expand/reduce)
https://academics.waldenu.edu/catalog/courses/nurs-1/8302
Week 8: The Application of Quality Improvement Models in Organizations and Systems
Discussion: Quality Improvement Models
What is the best way to implement quality improvement? What particular strategies and/or models should be used when developing a plan? Throughout the past 7 weeks, you have explored quality improvement in healthcare and nursing practice, and you will continue this exploration by analyzing specific quality improvement models. What models might work best in your nursing practice or healthcare organization?
Healthcare is complex and varied; therefore, quality improvement cannot be a one-sized fits all approach. To fit the complex and varied needs of an organization, there are multiple strategies and methods to implement quality improvement.
Photo Credit: Getty Images/iStockphoto
For this Discussion, select one quality improvement model to explore and analyze. Using the selected model, consider how this model might be implemented in your healthcare organization or nursing practice. Examine the effectiveness of this model and consider how this model might be applied to address impacts to adverse events for nursing practice.
To Prepare:
Review the Learning Resources for this week, and reflect on the different quality improvement models presented.
Select one quality improvement model from the following to focus on for this Discussion:
Root Cause Analysis (RCA)
A3
Lean
Plan, Do, Study, Act (PDSA)
Reflect on the quality improvement model you selected, and consider how it might be implemented in your healthcare organization or nursing practice.
For this discussion, I’ll focus on the Plan, Do, Study, Act (PDSA) model, a widely recognized approach to quality improvement in healthcare.
The PDSA model is particularly well-suited for implementation in nursing practice and healthcare organizations due to its iterative and systematic approach to testing and implementing changes. Here’s how the PDSA model works:
**Plan**: In the planning phase, teams identify a specific problem or opportunity for improvement, set clear and measurable objectives, and develop a plan for change. This includes defining the scope of the project, identifying key stakeholders, and outlining the steps needed to test the proposed changes.
**Do**: During the implementation phase, teams execute the planned changes on a small scale. This might involve piloting new processes, protocols, or interventions in a controlled environment to assess feasibility and effectiveness. Data is collected to monitor the implementation process and measure outcomes.
**Study**: In the study phase, teams analyze the data collected during the implementation phase to evaluate the impact of the changes. This includes assessing whether the changes achieved the desired outcomes, identifying any unexpected consequences or barriers, and determining areas for further improvement.
**Act**: Based on the findings from the study phase, teams make adjustments to the plan and scale up successful changes or modify unsuccessful ones. Lessons learned from the initial cycle inform subsequent cycles of the PDSA process, leading to continuous improvement over time.
Implementing the PDSA model in a healthcare organization or nursing practice involves several key steps:
**Identify Improvement Opportunities**: Nursing leaders and frontline staff collaborate to identify areas for improvement, such as reducing medication errors, improving patient satisfaction scores, or streamlining discharge processes.
**Form Quality Improvement Teams**: Multi-disciplinary teams are formed to lead improvement initiatives, consisting of nurses, physicians, quality improvement specialists, and other relevant stakeholders.
**Set SMART Goals**: Teams establish specific, measurable, achievable, relevant, and time-bound (SMART) goals for improvement projects, ensuring clarity and focus.
**Execute PDSA Cycles**: Teams conduct iterative PDSA cycles to test changes on a small scale, gathering feedback and data at each step to inform decision-making.
**Monitor Progress**: Regular data collection and analysis are conducted to track progress towards goals and identify areas needing further refinement.
**Scale Successful Changes**: Changes that demonstrate positive outcomes are implemented on a broader scale, while unsuccessful changes are modified or discontinued.
The PDSA model offers several advantages for addressing adverse events in nursing practice. By systematically testing changes on a small scale, healthcare teams can identify and mitigate potential risks before implementing them more broadly. Additionally, the iterative nature of the PDSA process allows for continuous learning and adaptation, enabling organizations to respond effectively to unexpected challenges and sustain improvement efforts over time.
In summary, the Plan, Do, Study, Act (PDSA) model provides a structured framework for quality improvement in nursing practice and healthcare organizations, allowing teams to systematically test and implement changes to address adverse events and improve patient outcomes.
Week 8: The Application of Quality Improvement Models in Organizations and Systems
By Day 3 of Week 8
Post a brief explanation of the quality improvement model you selected, including a description of the components that make up this model. Be specific. Then, explain how this quality improvement model might be implemented in you healthcare organization or nursing practice in response to an adverse event requiring quality improvement. Be specific and provide examples.
The quality improvement model I selected is the Plan, Do, Study, Act (PDSA) model.
The PDSA model is a systematic, iterative approach to quality improvement that consists of four key components:
**Plan**: In this phase, teams identify a specific problem or opportunity for improvement and develop a plan to address it. This involves setting clear objectives, defining the scope of the project, identifying key stakeholders, and outlining the steps needed to test proposed changes.
**Do**: During the implementation phase, teams execute the planned changes on a small scale. This might involve piloting new processes, protocols, or interventions in a controlled environment to assess feasibility and effectiveness. Data is collected to monitor the implementation process and measure outcomes.
**Study**: In the study phase, teams analyze the data collected during the implementation phase to evaluate the impact of the changes. This includes assessing whether the changes achieved the desired outcomes, identifying any unexpected consequences or barriers, and determining areas for further improvement.
**Act**: Based on the findings from the study phase, teams make adjustments to the plan and scale up successful changes or modify unsuccessful ones. Lessons learned from the initial cycle inform subsequent cycles of the PDSA process, leading to continuous improvement over time.
Implementing the PDSA model in a healthcare organization or nursing practice in response to an adverse event requiring quality improvement involves the following steps:
Example: Medication Error Reduction
**Plan**: Identify the adverse event, such as medication errors leading to patient harm, and establish a quality improvement team comprising nurses, pharmacists, physicians, and quality improvement specialists. Set SMART goals, such as reducing medication errors by 50% within six months, and develop a plan to address root causes, such as inadequate medication reconciliation processes or lack of standardized protocols.
**Do**: Pilot test changes, such as implementing barcode scanning for medication administration or conducting medication reconciliation at transitions of care, in a single unit or department. Train staff on new processes and procedures and collect data on medication error rates before and after implementation.
**Study**: Analyze the data collected to assess the impact of the changes on medication error rates. Determine whether the changes achieved the desired outcomes, identify any unintended consequences or areas for improvement, and gather feedback from staff and patients.
**Act**: Based on the study findings, refine the medication error reduction strategies as needed and implement them on a broader scale across the organization. Provide ongoing education and training to staff, monitor medication error rates regularly, and adjust interventions as necessary to sustain improvements over time.
By utilizing the PDSA model, healthcare organizations and nursing practices can systematically test and implement changes to address adverse events, such as medication errors, and continuously improve patient safety and quality of care.
By Day 6 of Week 8
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different quality improvement model than you. Suggest an additional strategy on how your colleague may implement the quality improvement model they selected in their healthcare organization or nursing practice.
**Colleague A: Lean**
Lean methodology focuses on eliminating waste and maximizing value in processes. Its key principles include identifying value from the customer’s perspective, mapping the value stream, creating flow, establishing pull, and continuously seeking perfection.
Implementing Lean in a healthcare organization or nursing practice involves several steps:
**Identify Value**: Determine what activities are valued by patients and eliminate non-value-added activities.
**Value Stream Mapping**: Map out the current processes involved in delivering care, including any inefficiencies or bottlenecks.
**Create Flow**: Streamline processes to create a smooth flow of work, reducing delays and unnecessary handoffs.
**Establish Pull**: Align the delivery of care with patient demand to prevent overproduction or underproduction of services.
**Continuous Improvement**: Implement a culture of continuous improvement, where frontline staff are empowered to identify and address waste.
For example, in response to an adverse event such as medication errors, a Lean approach could involve analyzing the medication administration process. By mapping out the current workflow, identifying areas of waste or inefficiency (such as excessive waiting times or unnecessary steps), and implementing standardized protocols or visual cues to improve communication and prevent errors, Lean principles can help streamline the medication administration process and reduce the risk of adverse events.
—
**My Response to Colleague A:**
Your approach to implementing Lean methodology in response to adverse events like medication errors is commendable. An additional strategy you might consider is incorporating error-proofing mechanisms, also known as poka-yoke, into the process. Poka-yoke devices or systems are designed to prevent errors from occurring or to detect errors before they reach the patient.
For instance, in the medication administration process, you could introduce barcoding systems or electronic medication administration records (eMARs) to verify the right medication, dose, route, and patient before administration. Implementing these error-proofing mechanisms aligns with Lean principles by eliminating the potential for errors at the source and ensuring consistent quality in care delivery.
By integrating poka-yoke strategies into your Lean initiatives, you can enhance patient safety and further optimize processes to mitigate the risk of adverse events in your healthcare organization or nursing practice.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 8 Discussion Rubric
Post by Day 3 of Week 8 and Respond by Day 6 of Week 8
To Participate in this Discussion:
Week 8 Discussion
What’s Coming Up in Module 5?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
In the next module, you will conclude your exploration of quality improvement. You will explore the methods and tools used to improve patient safety and quality through your exploration of leadership and change. You will also submit your certificate of completion of the IHI Modules required for this course.
Looking Ahead: IHI Modules
This Assignment requires completion of 13 IHI Open School modules and the completion of the Certificate of Completion at the Basic level. There are 13 modules that you must complete over the course of these 11 weeks.
Week 8: The Application of Quality Improvement Models in Organizations and Systems
Improvement Capability
Patient Safety
QI 101: Introduction to Health Care Improvement
PS 101: Introduction to Patient Safety
QI 102: How to Improve With the Model for Improvement
PS 102: From Error to Harm
QI 103: Testing and Measuring Changes With PDSA Cycles
PS 103: Human Factors and Safety
QI 104: Interpreting Data: Run Charts, Control Charts, and Other Measurement Tools
PS 104: Teamwork and Communication in a Culture of Safety
QI 105: Leading Quality Improvement
PS 105: Responding to Adverse Events
Triple Aim for Populations
Person and Family-Centered Care
TA 101: Introduction to the Triple Aim for Populations
PFC 101: Introduction to Person- and Family-Centered Care
Leadership
L 101: Introduction to Healthcare Leadership
To access the IHI Certificate Program, go to IHI.org and register to create an account. Be sure to enter Walden University as your organization. Under Role, you will select student. Under Organization, you will select school, and under education type, you will select nurse.
Go to the Education tab, and select Open School Courses. Click on Online Courses, and then on Certificates and CEUs. You want to ensure that you are viewing the Basic Certificate in Quality and Safety. Click on Earn Your Certificate Today, and you should be in your student dashboard to begin completing the IHI modules. You will want to click on Go to your Learning Center. On the left-side navigation menu, you will want to Search Catalog to search for—and enroll in—each of the 13 modules required for this certificate.
You will earn contact hours for each module, and once all 13 are completed, you will download the certificate of achievement. Please save this certificate. You will be required to upload this to gradebook in evidence of your completion.
You must complete all IHI modules and submit your certificate by Day 2 of Week 11.
Next Module
Week 8: The Application of Quality Improvement Models in Organizations and Systems
The post NURS 8302 Week 8: The Application of Quality Improvement Models in Organizations and Systems appeared first on Destiny Papers.
