Consider the influence of leadership and improvement teams in sustaining improvement efforts. Ask yourself: What specific strategies can leaders and my improvement team use to sustain our improvement initiative?
Application 1: Measuring Quality Guidelines .
In an 8 to 10 page paper, describe three rate based measurements of quality.
Your paper must be fully annotated, written in scholarly voice, and compliant with APA 6th edition style.
Select three rate based measurements of quality that you will use as the primary basis for this paper.
These measurements must relate to some aspect of clinical or service quality that directly relates to patient care or the patient’s experience of care. For the purposes of this assignment, an analysis of staffing levels is not permitted. You can find useful information on quality indicators that are of interest to you on these websites and resources. You may choose only one of the three measures to be some form of patient satisfaction measure.
http://www.qualityindicators.ahrq.gov/
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIQualityMeasures.html
http://www.medicare.gov/hospitalcompare/search.html?AspxAutoDetectCookieSupport=1
http://www.cdc.gov/HAI/surveillance/index.html
http://www.ihi.org/resources/Pages/IHIWhitePapers/AGuidetoMeasuringTripleAim.aspx
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalHCAHPS.html
http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/index.html?redirect=/cahps/
http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/HOS/index.html?redirect=/hos/
Deconstruct each measure to include descriptions of the following:
– The definition of the measure
– The numerical description of how the measurement is constructed (the numerator/denominator measure counts, the formula used to construct the rate, etc.)
– Explain how the data for this measure are collected
– Describe how the measurement is compared externally to other like settings; differentiate between the actual rate and a percentile ranking.
– Explain whether the measure is risk adjusted or not. If so, explain briefly how this is accomplished.
– Describe how goals might be set for each measure in an aggressive organization, which is seeking to excel in the marketplace.
Describe the importance of each measure to a chosen clinical organization and setting.
Using these websites and resources you can choose a hospital, a nursing home, a home health agency, a dialysis center, a health plan, an outpatient clinic or private office; a total population of patient types is also acceptable, but please be specific as to the setting. That is, if you are interested in patients with chronic illness across the continuum of care, you might hone in a particular healthplan, a multispecialty practice setting or a healthcare organization with both inpatient and outpatient/clinic settings. Faculty appointments and academic settings are not permitted for this exercise. For all other settings, consult the instructor for guidance. You do not need actual data from a given organization to complete this assignment.
Relate each measure to patient safety, to the cost of poor quality, and to the overall cost of healthcare.
Readings
• Course Text: Joshi, M.S., Ransom, E.R., Nash, D.B., & Ransom, S.B., (Eds.). (2014). The Healthcare Quality Book, 3rd ed. Chicago, IL: Health Adminisration Press.
o Chapter 5: Data Collection
o Chapter 6: Statistical tools for QI
• Article: Park, J., Konetzka, R. T., & Werner, R. M. (2011). Performing well on nursing home report cards: Does it pay off? Health Services Research, 46(2), 531–554. doi:10.1111/j.1475-6773.2010.01197.x
Retrieved from the Walden Library databases.
The study in this article evaluates whether or not nursing homes benefit from improvements in quality measures. Four financial outcomes are measured before and after the improvements are enacted. The study shows that the nursing homes that improved quality measures benefitted financially.
• Article: Suchy, K. (2010). A lack of standardization: The basis for the ethical issues surrounding quality and performance reports. Journal of Healthcare Management, 55(4), 241–251.
Retrieved from the Walden Library databases.
Because performance reports are easily found online, this article supports creating ethical guidelines for the performance reports of the health care industry. It compares nearly ten different organizations that provide performance reporting, and then it proposes an ethical framework and principles for public quality reporting.
• Article: Wachter, R. M., & Pronovost, P. J. (2009). Balancing “no blame” with accountability in patient safety. New England Journal of Medicine, 361(14), 1401–1406.
Retrieved from the Walden Library databases.
This article addresses the issue of individual accountability in health care organizations. It suggests moving from a culture within health care that does not place blame on individuals to a culture where individuals become more accountable.
• Web Resource: Centers for Medicare & Medicaid Services. (n.d.). Quality initiatives: Overview. Retrieved fromhttp://www.cms.gov/QualityInitiativesGenInfo/
Created by the U.S. Department of Health & Human Services, this website overviews quality initiatives that affect the health care industry. It also provides information and downloadable PDFs on the Post Acute Care Reform Plan and Development of Quality Indicators for Impatient Rehabilitation Facilities (IRF).
1B
Quality Metrics for Chronic Disease Management
According to the CDC, chronic diseases are the leading cause of death in the United States, with almost 50% of the population suffering from at least one chronic illness. As a result, almost 80% of health care spending is devoted to its management (CDC, 2010). To this end, the National Committee for Quality Assurance (NCQA) developed performance measures. These performance measures allow organizations to compare yearly quality improvement outcomes in the management of chronic diseases. As a nurse engaged in advanced practice, you may find yourself at the forefront of prevention and care management efforts.
To prepare:
• Review the National Committee for Quality Assurance report, presented in the Learning Resources, and examine current trends and measures associated with at least two chronic diseases. This information will form the basis for this Discussion.
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• Review examples of measures that address the management of chronic diseases for an inpatient setting that might not be relevant in an outpatient setting. Be sure to explore the companion metrics that influence a patient’s ability to manage chronic disease.
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• Consider how these metrics facilitate change and improve the management of chronic disease.
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• Examine the efficiency of current automated trigger systems for managing patient safety. Ask yourself: How do these automated trigger systems help improve quality of health care, patient education, and management of chronic illnesses?
By Day 3, post a cohesive response that addresses the following:
• Compare one quality metric for managing chronic disease that applies to your practice setting to ametric that applies in a different practice setting (i.e. hospital nurse compared to home health nurse).
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• Evaluate how these quality metrics facilitate change and improve the management of chronic disease.
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• Take a stance on the efficiency of current automated trigger systems to help manage patient safety. Do you believe these to be proactive or reactive responses when educating patients on disease management?
Learning Resources
Required Resources
This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources.
Readings
• Course Text: Joshi, M.S., Ransom, E.R., Nash, D.B., & Ransom, S.B., (Eds.). (2014). The Healthcare Quality Book, 3rd ed. Chicago, IL: Health Adminisration Press.
o Chapter 10: Dashboard & scorecards: tools for creating alignment
• Report: National Committee for Quality Assurance. (2014). The state of health care quality: Reform, the quality agenda and resource use. Washington, D. C.: National Committee for Quality Assurance.
Retrieved from http://www.ncqa.org/ReportsCards/HealthPlans/StateofHealthCareQuality.aspx
The findings in this annual report come from the National Committee for Quality Assurance (NCQA), and they describe the status of quality issues within the United States. The findings cover several categories including safety and potential waste, wellness and prevention, and chronic disease management.
• Article: Butcher, L. (2011). High standards. NCQA-approved practice a test for value-based care. Modern Healthcare, 41(11), 40.
Retrieved from the Walden Library databases.
In this article, an oncology practice is recognized by the National Committee for Quality Assurance. Although the practice has seen a decrease in patients due to cost increases, the quality of care has increased significantly. The practice is serving as a model for other oncology practices.
• Article: McKinney, M. (2010). Quality, not quantity. Costliest care not the best, says NCQA report. Modern Healthcare, 40(42), 8–9.
Retrieved from the Walden Library databases.
This article analyzes the findings of the National Committee for Quality Assurance’s State of Health Care Quality report and concludes that there is no correlation between spending and quality within health care organizations.
• Article: National Committee for Quality Assurance (NCQA). (2014). Healthcare effectiveness data and information set (HEDIS). Retrieved from http://www.ncqa.org/tabid/59/default.aspx
In this article at the NCQA website, the quality measurements for the Healthcare Effectiveness Data and Information Set (HEDIS) are given. This article provides up-to-date resources.
• Article: Brennan, N., & Shepard, M. (2010). Comparing quality of care in the Medicare program. American Journal of Managed Care. 16(11), 841–848.
Reprinted by permission of . via the Copyright Clearance Center
The authors of this article compare the difference in quality of care within health care organizations that use fee-for-service programs with Medicare and within organizations that use the Medicare Advantage program.
• Website: Agency for Healthcare Research and Quality. (n.d.). Retrieved from http://www.ahrq.gov/
The provided link takes you to the homepage of the Agency for Healthcare Research and Quality (AHRQ), where you can find information about improving safety and quality in the health care industry.
• Website: http://populationhealthalliance.org/
• Website: National Committee for Quality Assurance. (2014). Retrieved from http://www.ncqa.org/
This is the homepage for the NCQA. It contains extensive resources related to quality measurements for the health care industry.
• Website: Utilization Review Accreditation Commission. (2014). Retrieved from http://www.urac.org/
Visiting this website takes you to the homepage of URAC, which is the new name for what was formerly called the Utilization Review Accreditation Commission. URAC provides accreditation, offers education, and facilitates quality measurement programs.
Optional Resources
• Article: Wolfenden, J., Dunn, A., Holmes, A., Davies, C., & Buchan, J. (2010). Track and trigger system for use in community hospitals. Nursing Standard, 24(45), 35–39.
1C
Patient Safety and Quality Improvement Evaluation
A health care organization may have highly qualified doctors and nurses who meet quality indicators for technical quality; however, due to a lack of communication, empathy, and scheduled office hours, patient satisfaction is low. In the corporate world, the phrase “the customer is always right” is frequently used to emphasize the importance of meeting the needs and expectations of the consumer. How does this approach apply to health care?
Health care industries are now using quality improvement models that are very business-centric to improve the quality of care delivery, patient satisfaction, and safety. In this Discussion, you evaluate various quality improvement models and determine which model would best be applied in your practice setting to address a specific need. You also develop a mission statement for addressing the practice problem.
To prepare:
• Reflect on the various quality improvement models and their application in health care presented in the Learning Resources.
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• Evaluate the advantages and disadvantages of each model.
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• Consider how these models have been, or could be, applied in your practice setting.
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• Based on your selected area of need, define a practice problem and create a corresponding mission statement.
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• Investigate baseline data, and evaluate why this practice problem is a priority for improvement. Ask yourself: How does this practice problem in my organization compare to other organizations?
By Day 3, post a cohesive response that addresses the following:
• Summarize any practice problem relevant to your setting of interest and share your mission statement. Be sure to include the data that justifies why you feel a change is needed in this specific area.
• Explain how the PDSA model might be applied , giving specific reasoning as to why this model best fits the needs of your practice problem. Describe how the practice problem you describe might be of interest to any accreditation initiative.
Learning Resources
Required Resources
This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources.
Readings
• Course Text: Joshi, M.S., Ransom, E.R., Nash, D.B., & Ransom, S.B., (Eds.). (2014). The Healthcare Quality Book, 3rd ed. Chicago, IL: Health Adminisration Press.
o Chapter 19: Accreditation: Its role in driving accountability in healthcare.
• Article: Menaker, R. (2010). Leadership strategies in healthcare. The Journal of Medical Practice Management, 24(6), 339–343.
Retrieved from the Walden Library databases.
From increasing regulation to costs, this article evaluates the challenges that the health care industry faces. It then covers how transformational leadership and leadership strategies can help health care organizations address these challenges.
• Article: Boyd, S., Aggarwal, I., Davey, P., Logan, M., & Nathwani, D. (2011). Peripheral intravenous catheters: the road to quality improvement and safer patient care. Journal of Hospital Infection, 77(1), 37–41. doi:10.1016/j.jhin.2010.09.011
Retrieved from the Walden Library databases.
A unit within a health care organization implements measures that increase quality of care. This article studies this process and explains the research and results involved.
2A
Quality Improvement Initiative
When attempting to garner support for a quality improvement initiative, it is important to demonstrate how the initiative supports the organization’s mission, vision, and values, as well as external factors that influence an organization’s priorities. Delivering a proposal for a quality improvement initiative requires clear, concise communication of the plan.
To prepare:
• Choose a QI initiative which has been the subject of focus in any healthcare setting. Explain the rationale that your senior leaders used in selecting this initiative for attention and focus.
• Explain how adverse events are handled in your organization from the public’s perspective and well as internally.
• Find a scholarly article or one from the public press, published within the last 5 years which recounts a serious error. Relate this error to any organization with which you have some familiarity.
By Day 3, post your response.
Readings
• Course Text: Joshi, M.S., Ransom, E.R., Nash, D.B., & Ransom, S.B., (Eds.). (2014). The Healthcare Quality Book, 3rd ed. Chicago, IL: Health Adminisration Press.
o Chapter 11: Patient safety and medical errors
• Article: Clarke, C. M., & Persaud, D. D. (2011). Leading clinical handover improvement: a change strategy to implement best practices in the acute care setting. Journal of Patient Safety, 7(1), 11–18. doi:10.1097/PTS.0b013e31820c98a8
Retrieved from the Walden Library databases.
Designed for leaders who want to improve quality care, this article focuses on clinical handovers that occur within acute care facilities. It provides a model for improvement and is intended to be a supplemental resource that can be used with the existing research and literature on this topic.
• Web Article: Sennett, C. (2010). Healthcare reform: Quality outcomes measurement and reporting. American Health & Drug Benefits. Retrieved from http://www.ahdbonline.com/article/healthcare-reform-quality-outcomes-measurement-and-reporting
The article on this website discusses features of the Patient Protection and Affordable Care Act (PPACA), focusing on the outcomes and implications for quality outcomes measuring and reporting.
Optional Resources
• Article: Lazarus, I.R. (2011). What will It take? Exploiting trends in strategic planning to prepare for reform. Journal of Healthcare Management, 56 (2), 89–93.
3A-(10)
Evidence-Based Practice Models
Last week, you explored key factors that contribute to patient safety challenges using root cause analysis. This week builds on that foundational awareness with a focus on the application of evidence-based practice models as a strategy to improve patient safety and other quality dimensions. In this Discussion, consider how these strategies can sustain practice changes.
To prepare:
• Find a nursing research study published in a peer reviewed nursing journal on any patient outcomes focused topic.
By Day 2, post a 3 page paper, summarzing the study.
Be sure to include the following key items in your paper:
• Describe key variables studied in the project
• Explain the theoretical linkages posed by the study authors
• Describe the research method, choice of sample, and instruments used to measure the variables under study.
• Summarize the strides that the authors took to demonstrate reliability and validity of the instruments used in the study.
• Describe the results and the extent to which the authors’ hypotheses were accepted or rejected.
• Provide a concluding paragraph as to how this study would specifically support evidence based practice and a QI initiative.
Critique at least 2 of your colleagues’ research summaries.
Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.
Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.
Learning Resources
Required Resources
This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources.
Readings
• Course Text: Joshi, M.S., Ransom, E.R., Nash, D.B., & Ransom, S.B., (Eds.). (2014). The Healthcare Quality Book, 3rd ed. Chicago, IL: Health Adminisration Press.
o Chapter 14: Leadership for Quality
o Chapter 16: Implementing quality as the core organizational strategy
• Article: Baur, C. (2011). Calling the nation to act: Implementing the national action plan to improve health literacy. Nursing Outlook, 59(2), 63–69.
Retrieved from the Walden Library databases.
This article describes the aspects of the National Action Plan to Improve Health Literacy. It starts by covering the background and objectives of the plan and then moves to its vision and goals.
• Article: Ferrara, L. R. (2010). Integrating evidence-based practice with educational theory in clinical practice for nurse practitioners: Bridging the theory practice gap. Research & Theory for Nursing Practice, 24(4), 213–216.
Retrieved from the Walden Library databases.
The author of this article discusses using constructivist theory to teach nurse practitioner students to use evidenced-based practice. She focuses on introducing the student’s theoretical knowledge into real-life practice.
• Article: Grant, B., Colello, S., Riehle, M., & Dende, D. (2010). An evaluation of the nursing practice environment and successful change management using the new generation Magnet Model. Journal of Nursing Management, 18(3), 326–331. doi:10.1111/j.1365-2834.2010.01076.x
Retrieved from the Walden Library databases.
Health care organizations have implemented the Magnet Model as a way to successfully implement practice change. This article examines the aspects of this process.
• Article: Lavoie-Tremblay, M., Bonin, J.-P., Lesage, A., Farand, L., Lavigne, G. L., & Trudel, J. (2011). Implementation of diagnosis-related mental health problems: Impact on health care providers. Health Care Manager, 30(1), 30(1): 4-14 (50 ref). doi:10.1097/HCM.0b013e3182078a95
Retrieved from the Walden Library databases.
The study within this article analyzes two cases related to the implementation of diagnosis-related mental health programs.
• Article: Mark, D. D., Latimer, R. W., & Hardy, M. D. (2010). “Stars” aligned for evidence-based practice: a TriService initiative in the Pacific. Nursing Research, 59(1), S48–S57. doi:10.1097/01.NNR.0000313506.22722.53
Retrieved from the Walden Library databases.
Nurses from a military health care system in Hawaii established ways to use and evaluate evidence-based practices. This article details the process and results of this collaborative effort between the Army, Air Force, and Navy.
• Article: Scobbie, L., Dixon, D., & Wyke, S. (2011). Goal setting and action planning in the rehabilitation setting: Development of a theoretically informed practice framework. Clinical Rehabilitation, 25(5), 468–482. doi:10.1177/0269215510389198
Retrieved from the Walden Library databases.
In order to develop a theory-based framework for setting goals, the authors of this article use casual modeling to determine effective patient outcomes. They identifies four major components of the framework that can be used to set effective goals.
Optional Resources
• Article: Schifalacqua, M. M., Mamula, J., & Mason, A. R. (2011). Return on investment imperative: the cost of care calculator for an evidence-based practice program. Nursing Administration Quarterly, 35(1), 15–20.
4A-(11)
Evaluating and Sustaining Improvement
The downfall of many quality improvement initiatives is the inability to sustain improvements. Last week, you considered the use of evidence-based practice models as a method for sustaining practice changes to improve quality. This week’s Discussion builds on those concepts of sustainability. You evaluate measurement mechanisms and explore strategies that leadership and improvement teams can use to sustain improvement efforts.
To prepare:
• Review the evaluation tools presented in the Learning Resources and how the tools can be used to promote sustainability.
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• Select a measurement mechanism that can be used to evaluate your quality improvement initiative. You may wish to conduct additional research on the use of measurement mechanisms to sustain outcomes of improvement initiatives.
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• Consider the influence of leadership and improvement teams in sustaining improvement efforts. Ask yourself: What specific strategies can leaders and my improvement team use to sustain our improvement initiative?
By Day 3, post a cohesive scholarly response that addresses the following:
• Evaluate the influence of leadership and improvement teams in sustaining improvement efforts. Present a succinct analysis of three or more strategies leaders and teams can use in your response.
Readings
• Course Text: Applying Quality Management in Healthcare: A Systems Approach
•
o Review Chapter 10, “Measuring Process and System Performance”
When analyzing performance with complex systems, there are multiple factors that managers must consider before making decisions based on the data. This chapter covers these factors.
• Article: Richardson, A., & Storr, J. (2010). Patient safety: A literative review on the impact of nursing empowerment, leadership and collaboration [corrected] [published erratum appears in INT NURS REV 2010 Mar;57(1):158]. International Nursing Review, 57(1), 12–21. doi:10.1111/j.1466-7657.2009.00757.x
Retrieved from the Walden Library using the CINAHL Plus with Full Text database.
This article analyzes how nurses can improve patient safety. It identifies certain knowledge gaps that inhibit nurses’ ability to improve patient safety that must be addressed before they can effectively make contributions.
• Article: Bigelow, L., Wolkowski, C., Baskin, L., & Gorko, M. (2010). Lean Six Sigma: Sustaining the gains in a hospital laboratory. Clinical Leadership & Management Review, 24(3), 1–14.
Retrieved from the Walden Library using the CINAHL Plus with Full Text database.
In this article, a health care organization uses Lean Six Sigma to improve performance, but it does not initially achieve the desired results. It then utilizes an Operational Performance Improvement office from within the organization to receive better training in Lean Six Sigma and it is finally able to improve performance.
• Article: Murphree, P., Vath, R. R., & Daigle, L. (2011). Sustaining Lean Six Sigma projects in health care. Physician Executive, 37(1), 44–48.
Retrieved from the Walden Library using the MEDLINE with Full Text databases.
The authors of this article consider ways to keep Lean Six Sigma projects operating instead of closing them. They distinguish between closing and controlling, the latter being the last phase in Lean Six Sigma. According to the authors, many organizations close Lean Six Sigma projects when they should be controlling them.
Optional Resources
• Web Article: Reh, F. J. (2011). Key performance indicators (KPI): How an organization defines and measures progress toward its goals.Retrieved from http://management.about.com/cs/generalmanagement/a/keyperfindic.htm
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