The milestone assignments in this course are to help you prepare for the final project PowerPoint (PPT) presentation. Milestone Two provides the support for the quality improvement initiative with details about the leadership style and existing interprofessional strategies within the healthcare organization. You will survey evidence-based resources to support your quality improvement initiative, analyze the impact on healthcare reimbursement, and assess models or theories of change. You will continue to use the patient care issue that you chose in Milestone One as the focus of this work. Use evidence-based resources to provide support for each section. Your instructor will provide feedback for each milestone. You should incorporate this feedback into the final project PPT presentation.
Prompt:
For this milestone, use evidence-based resources to address the following critical elements:
1. Support:
a. Analyze the current LEADERSHIP STYLE and its role in the planning, analysis, and implementation of quality improvement initiatives within the organization.
b. Detail EXISTING INTERPROFESSIONAL STRAGIES within the organization that may influence or impact new and existing quality improvement initiatives.
c. Appraise EVIDENCE-BASED RESORUCES for their support of the quality improvement initiative as a method of advancing quality patient care outcomes and healthcare reimbursement.
d. Analyze the effect the quality improvement initiative will have on the relationship between the healthcare problem and HEALTHCARE REIMBURSEMENT.
e. Assess a CHANGE THEORY or model for its applicability to the quality improvement initiative. )Examples: Lewin’s, Lippitt’s, Roger’s)
I strongly suggest that you use the prompts as headers!! (the parts above that I upper cased are the headers)
What to Submit:
Your submission should be a Word document approximately 3–5 pages in length (not including title and reference pages) and should be formatted using proper APA publication format. This submission should include at least two evidence-based references published within the last five years.
Required Resources (if they help):
Shapiro Library Article: https://ezproxy.snhu.edu/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fscholarly-journals%2Fimportance-leadership-style-towards-quality-care%2Fdocview%2F1988726595%2Fse-2%3Faccountid%3D3783
This article reviews literature for connections between leadership styles and healthcare outcomes.
Article: https://www.snhu.edu/about-us/newsroom/2020/09/5-leadership-styles-in-nursing
This article presents leadership types from SNHU faculty member, Dr. Kimberly Gibbons.
Shapiro Library Article: https://ezproxy.snhu.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=eft&AN=134910481&site=eds-live&scope=site
This article provides insight into the differences between centralized and decentralized organizational structures.
Article: https://www.ncbi.nlm.nih.gov/books/NBK549862/
This article provides an overview of shared governance and its application to multiple aspects of nursing care. Interprofessional collaboration is also discussed in this article.
Website: https://www.nursingworld.org/organizational-programs/magnet/magnet-model/
This American Nurses Credentialing Center website provides information about Magnet accreditation requirements, history, and the requisite elements to create a magnet culture.
Shapiro Library Article: https://ezproxy.snhu.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=147194717&site=eds-live&scope=site
This article provides a great review of strategies that use IPC in healthcare.
Shapiro Library Article: https://ezproxy.snhu.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=asn&AN=123884541&site=eds-live&scope=site
This article helps to connect the financial impact of nursing on healthcare.
Resource: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HVBP/Hospital-Value-Based-Purchasing.html
Review this resource from the Centers for Medicare and Medicaid Services (CMS) for information on value-based purchasing.
Article: https://www.ncbi.nlm.nih.gov/books/NBK459380/#!po=10.0000
This article provides information about using change theories for implementing change processes. Lewin, Lippett, Rogers, and Kotter are highlighted in this publication.
Additional Support (Optional):
Shapiro Library Article: https://ezproxy.snhu.edu/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fscholarly-journals%2Fleadership-styles-influence-on-quality-nursing%2Fdocview%2F2253104244%2Fse-2%3Faccountid%3D3783
This article investigates leadership styles and their effect from the nurse’s point of view.
Shapiro Library Article: https://www-tandfonline-com.ezproxy.snhu.edu/doi/full/10.1080/14783363.2017.1421062
This article reviews differences in quality indicators based on levels of leadership functions.
Shapiro Library Article: https://www-sciencedirect-com.ezproxy.snhu.edu/science/article/pii/S1541461217301921?
This article discusses the benefits of shared governance for improved patient outcomes.
Shapiro Library Article: https://ezproxy.snhu.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=146412755&site=eds-live&scope=site
This article presents a quality improvement initiative that uses IPC as an important aspect of patient care.
Shapiro Library Article: https://ezproxy.snhu.edu/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fscholarly-journals%2Fselecting-best-theory-implement-planned-change%2Fdocview%2F1329184689%2Fse-2%3Faccountid%3D3783
This article provides an overview of various change theories and their application to nursing practice.
ALSO FOR A REMINDER THIS IS WHAT I PUT FOR THE FIRST PART OF THE MILESTONE:
Introduction and Initiative
In today’s dynamic healthcare environment, hospitals and healthcare facilities must rigorously examine their core attributes to enhance the quality of care they offer. Notably, quality of care is intrinsically tied to the financial aspects of healthcare reimbursement. A critical issue demanding attention is patient falls, which have a substantial impact on both patient safety and economic implications. According to statistics, unintentional injuries, often stemming from falls, are the fifth leading cause of death in adults aged 65 and older, accounting for 66% of such fatalities (World Health Organization, 2021). Notably, falls can result in serious injuries, leading to surgery, pain management, and diagnostic procedures. These incidents can have dire financial consequences for healthcare establishments, as Centers for Medicare and Medicaid Services may withhold reimbursement for healthcare-associated injuries, resulting in financial penalties (LeLaurin & Shorr, 2019). To address this issue, a comprehensive fall reduction initiative is proposed, which will involve a multidisciplinary falls committee, continuous environmental assessments, and more effective utilization of fall risk assessment tools. This initiative aims to reduce both the incidence of falls and the subsequent financial burden.
Organization
The selected healthcare organization, Quaboag Rehabilitation, and Skilled Care Center, a 147-bed facility in West Brookfield, Massachusetts, exhibits key characteristics that significantly impact its quality of care and the intricate connection between quality outcomes and healthcare reimbursement. One glaring concern is the recurrent occurrence of patient falls, which not only jeopardizes patient safety but also has substantial financial implications. This healthcare organization’s values, or perhaps the lack of an emphasized commitment to fall prevention, play a pivotal role in quality outcomes. Despite having multiple interventions in place, such as alarms, falls continue to transpire, and there seems to be a shift towards an alarm-free facility, possibly due to the inefficacy and room for error associated with alarm use. Consequently, the organization faces considerable financial burdens regarding surgery, diagnostic testing, and potential reimbursement penalties. Furthermore, the varying commitment levels of nurse leaders within the facility impact the overall approach to fall reduction. The lack of a consistent vision and proactive plan for mitigating falls reflects a crucial issue in this healthcare organization. To ensure quality outcomes and adequate reimbursement, this organization must address its values, consistency in leadership commitment, and comprehensive fall prevention strategies.
Quality Outcome Problem
A substantial quality outcome problem in patient care, intimately intertwined with financial implications, is the recurring issue of patient falls within healthcare facilities. Research highlights that fall among nursing home residents, particularly those aged 65 and older, represent a significant concern (LeLaurin & Shorr, 2019). Unintentional injuries rank as the fifth leading cause of death in this demographic, two-thirds of which are fall-related. Each year, about $50 billion is spent on medical costs related to older adult falls—fatal injuries total $754 million, and the remainder is attributed to non-fatal fall injuries (CDC, 2023). Preventing falls can involve costly interventions, such as fall risk assessments and specialized instruments. At the same time, healthcare establishments must report incidents resulting in serious injuries, potentially resulting in reimbursement penalties. This pressing problem provides a compelling quality improvement opportunity where healthcare organizations can not only enhance patient safety and outcomes but also alleviate the financial burden associated with fall-related injuries through comprehensive fall reduction initiatives.
Purpose/Proposal Initiative
A proposed initiative to address the critical patient care problem of recurrent falls within healthcare organizations like Quaboag Rehabilitation and Skilled Care Center necessitates a multifaceted approach. First, forming a fall reduction Committee comprising a diverse team of healthcare professionals, including nurses, physical therapists, and pharmacists, is crucial to bringing different perspectives and expertise. This committee should conduct regular environmental rounds, focusing on high-risk areas, and utilize this opportunity to discuss and implement immediate interventions. For instance, data indicates that falls often occur on Sundays and Mondays, particularly following meals; therefore, proactive interventions, such as additional staff during these peak times, could be implemented. Medication reviews should also be part of the initiative, as some falls are linked to medication side effects. Polypharmacy should be addressed, reducing the risk of falls tied to medication usage.
Additionally, the facility should harness the full potential of fall risk assessment tools, not merely for identifying high-risk patients but also for tailoring individualized care plans to mitigate fall risks. This initiative should emphasize ongoing training and awareness among healthcare staff about fall prevention strategies and their significance. The success of the initiative hinges on fostering a culture of shared responsibility among all healthcare professionals and a commitment to comprehensive, data-driven strategies that address the complex interplay between patient safety and financial considerations in the context of falls.
SMART GOAL
"Within the next 12 months, reduce the rate of patient falls during peak times (Sundays and Mondays) following meals by 20%, as measured by incident reports and a decrease in the number of reported falls, while maintaining or improving overall patient satisfaction scores."
Quality Improvement Model
The selection of an appropriate quality improvement model is pivotal for the success of the fall reduction initiative at Quaboag Rehabilitation and Skilled Care Center. To that end, the Plan-Do-Study-Act (PDSA) cycle is a practical choice. The PDSA model’s iterative nature aligns with the need for ongoing evaluation and adjustment in the fall reduction program, as emphasized by the Agency for Healthcare Research and Quality (AHRQ) (Agency for Healthcare Research and Quality, 2020). This cyclic approach enables continuous small-scale testing and adaptation of interventions, such as staffing changes and medication reviews, which is highly relevant in addressing the multifaceted issue of patient falls (Agency for Healthcare Research and Quality, 2020). Furthermore, the PDSA model allows for real-time data collection and analysis, a crucial element in monitoring the effectiveness of initiatives and tailoring strategies to the specific needs of the facility, thus maximizing its applicability and utility in promoting change and enhancing patient safety (Agency for Healthcare Research and Quality, 2020).
References
Agency for Healthcare Research and Quality. (2020, September). Plan-Do-Study-Act (PDSA)
directions and examples. Www.ahrq.gov. https://www.ahrq.gov/health-literacy/improve/precautions/tool2b.html
CDC. (2023, September 6). Older Adult Falls Data | Fall Prevention | Injury Center | CDC. Www.cdc.gov. https://www.cdc.gov/falls/data/index.html#:~:text=
LeLaurin, J. H., & Shorr, R. I. (2019). Preventing Falls in Hospitalized Patients. Clinics in Geriatric Medicine, 35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007
World Health Organization. (2021). Falls. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/falls
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