The purpose of this assignment is to apply the concepts you have learned in this course to a situation you have encountered. Choose one quality or patient safety concern with which you are familiar and that you have not yet discussed in this course. In a 1,250-1,500-word essay, reflect on what you have learned in this course by applying the concepts to the quality or patient safety concern you have selected. Include the following in your essay:
Briefly describe the issue and associated challenges.
Explain how EBP, research, and PI would be utilized to address the issue.
Explain the PI or QI process you would apply and discuss why you chose it.
Describe your data sources, including outcome and process data.
Explain how the data will be captured and disseminated.
Discuss which organizational culture considerations will be essential to the success of your work. This assignment uses a rubric.
Use a minimum of four peer-reviewed, scholarly sources as evidence.
Overview of Quality in Health Care
Student’s Name
Institutional Affiliations
Overview of Quality in Healthcare
As nurses play their role of providing care to patients, they also play a key role in protecting patient safety by identifying issues that might harm patients and contribute to negative health outcomes. The best way to address issues that cause patient safety concerns is to implement quality improvement interventions (Ogrinc et al., 2021). Organizations must implement evidence-based approaches when addressing quality issues in their organizations. Nurses should assist their organization in identifying the right outcome/process measures to use and to collect appropriate data for those measures (Backhouse & Ogunlayi, 2020). The purpose of this assignment is to describe a patient safety issue in the organization including the best evidence-based interventions and organizational culture considerations to address such issues.
Patient Safety Concern and Associated Challenges
Rising incidences of catheter-associated urinary tract infections (CAUTIs) are a big threat to patient safety. A previous organization recorded rising incidences of CAUTIs over a period of six months in a row. Many patients developed infections at the catheter site within two to five days after indwelling catheter insertion. Rising cases of CAUTIs are associated with numerous in healthcare settings. These challenges prevent an organization from meeting the Quadruple aim (Shenoy, 2021). For example, CAUTIs contribute to prolonged hospital stay which affects patient outcomes and results in negative patient experience. Additionally, as many patients continue to develop CAUTIs, there is always a rise in the workload for nurses. This causes burnout, reduces provider satisfaction, and increases nurse turnover. Moreover, the additional costs that an organization incurs when caring for patients who develop CAUTIs negatively affect a hospital’s budget (Gad & AbdelAziz, 2021). Implementing quality improvement interventions to address CAUTIs helps an organization to improve patient outcomes, enhance patient satisfaction/experience, improve clinician satisfaction, and reduce costs.
How EBP, Research, and PI Would Be Utilized to Address the Issue
A healthcare organization that is experiencing rising incidences of CAUTIs can implement evidence-based practice (EBP), research, and performance improvement (PI) to promote patient safety. The Oncology Nursing Society (2022) defines EBP as the process of integrating the best available evidence with patients’ preferences and clinical expertise to inform clinical decisions when working with patients with similar health problems. When utilizing EBP to address rising incidences of CAUTIs, healthcare professionals in the organization should synthesize multiple and related peer-reviewed articles to gather best practice evidence that when implemented, will help to reduce incidences of CAUTIs. A systematic exploration conducted by a team of investigators to answer a specific research question is what is defined as research. In the healthcare profession, research is usually conducted to either produce new knowledge or validate an existing one (Chien, 2019). Nurses in a healthcare setting can conduct research in order to either produce new knowledge or validate an existing one regarding the effectiveness of a particular intervention in improving CAUTIs. According to Backhouse and Ogunlayi (2020), quality or performance improvement encompasses the combined and continuous efforts that a healthcare organization makes to change clinical processes and generate better outcomes for patients within its setting. In the current scenario, a healthcare organization can implement a PI or a QI initiative by redesigning work processes within its settings to eliminate factors that might be contributing to rising cases of CAUTIs. This will promote patient safety, improve patient outcomes, and enhance patient experience.
The PI or QI process and Rationale
An organization’s success in addressing a patient safety issue depends on the appropriate choice of a performance improvement (PI) or a quality improvement (QI) process. According to the Agency for Healthcare Research and Quality (2022), a QI process must have some measurable characteristics that can also be analyzed, improved, and controlled. The QI or PI process that would be appropriate for addressing rising incidences of CAUTIs in a healthcare organization is the Six Sigma approach. The rationale for selecting the Six Sigma approach is that it is widely used in today’s healthcare settings to direct quality improvement initiatives aimed at improving patient safety. Besides, many healthcare organizations have successfully used the Six Sigma approach to resolve patient safety issues within their settings (Ninerola et al. 2020). The organization can choose to either utilize the Six Sigma approach alone or use it together with other QI processes such as the Plan, Do, Study,
When using the Six Sigma approach to improve CAUTIs, the healthcare organization should follow the right steps that are aligned with the approach. The application of the Six Sigma Quality Model to address the causes of the rising CAUTI rates will follow the define, measure, analyze, improve, and control (DMAIC) methodology (Agency for Healthcare Research and Quality, 2020). During the process, the healthcare organization should Define the problem using terms that can be measured. It should then Measure the severity of the problem by assessing the baseline performance. This should be followed by the Analyze phase where the facility should evaluate the problem by isolating the top causes associated with the measure. It should then Improve the situation by executing evidence-based interventions to either prevent or eliminate the top causes. During the final phase of the Six Sigma approach, the healthcare organization should Control rates of CAUTIs completely by sustaining the change through continued monitoring of the interventions and communicating results (Agency for Healthcare Research and Quality, 2020). Generally, the Six Sigma to QI will enable the facility to create a healthcare environment that is free from factors that might lead to CAUTIs.
Data Sources (outcome and process data)
Both primary and secondary data sources are useful for gathering data for evaluating outcomes and processes during the implementation of a quality improvement initiative. The type of data that is collected directly from study participants without consulting any published resources is primary data. Conversely, secondary data is that type of data obtained from published resources such as journals and books (Ajayi, 2017). Outcome-related data capture metrics that reflect the impacts of quality improvement interventions on patients, employees, stakeholders (Institute of Healthcare Improvement, 2022). For example, the organization should collect primary data related to the impact of a QI intervention on the rates CAUTIs by interviewing nurses employed in the organization. To collect secondary data, it should synthesize published literature to retrieve evidence that supports the effectiveness of the QI intervention being implemented on CAUTIs. Process-related data capture metrics that track whether parts of a system that is followed to reduce rates of CAUTIs are performing as planned (Institute of Healthcare Improvement, 2022). An example of a process measure is the hourly reposition of patients to prevent patients from developing pressure ulcers. The facility should gather primary data related to the availability of hand hygiene policy for CAUTIs by surveying physicians employed in the organization. To collect secondary data, it should synthesize published literature to retrieve evidence that informs how the presence of a hand hygiene policy can help to reduce CAUTIs in healthcare organizations.
How the Data will be Captured and Disseminated
The best way to ensure the sustainability of a quality improvement initiative is to capture and disseminate information to stakeholders during and after the project. Primary data in a QI initiative aimed at improving CAUTIs is best captured using questionnaires or survey forms. The project team can capture secondary data by summarizing the results of article synthesis on a table (Ajayi, 2017). The organization can disseminate the results of a QI initiative using visual tools such as PowerPoint presentations, meetings, process boards, and process boards at the organizational level. It can also consider documenting the outcomes in brochures and journals to allow dissemination to other interested groups (Silver et al., 2016). Appropriate choice of dissemination strategy has a great influence on QI project sustainability.
Organizational Culture Considerations
The nature of an organization’s culture will determine whether a QI change will be able to generate long-term benefits for a healthcare organization. A crucial consideration for a facility that is recording rising cases of CAUTIs is to use a patient safety culture where every employee is committed to protecting patients from harm (Rogers et al., 2017). Most importantly, an organization should utilize a just culture that encourages accountability as well as open and honest reporting. A just culture will help to enhance patient safety by preventing employees from blaming one another whenever medical errors occur. It will also prevent the organization from punishing employees who make medical errors thereby promoting increased reporting of at-risk behaviors and errors that might lead to CAUTIs (Shah et al., 2021). For a just culture to work effectively, an organization needs to consider and strive to achieve crucial elements including human factor design, error prevention, and taking appropriate steps to prevent severe consequences of errors.
Conclusion
Every healthcare organization should strive to ensure patient safety. They should implement quality improvement interventions to address patient safety concerns such as rising incidences of CAUTIs. Effective communication with stakeholders and patient safety culture can help a healthcare organization to ensure the sustainability of a QI initiative.
References
Agency for Healthcare Research and Quality. (2020). Section 4: Ways to approach the quality improvement process. https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/4-approach-qi-process/sect4part2.html
Agency for Healthcare Research and Quality. (2022). Module 4: Approaches to quality improvement. https://www.ahrq.gov/ncepcr/tools/pf-handbook/mod4.html
Ajayi, V. O. (2017). Primary sources of data and secondary sources of data. Benue State University, 1(1), 1-6. 10.13140/RG.2.2.24292.68481
Backhouse, A., & Ogunlayi, F. (2020). Quality improvement into practice. BMJ (Clinical research ed.), 368, m865. https://doi.org/10.1136/bmj.m865.
Chien, L. Y. (2019). Evidence-based practice and nursing research. The Journal of Nursing Research: JNR, 27(4), e29. https://doi.org/10.1097/jnr.0000000000000346
Gad, M. H., & AbdelAziz, H. H. (2021). Catheter-Associated urinary tract infections in the adult patient group: a qualitative systematic review on the adopted preventative and interventional protocols from the literature. Cureus, 13(7), e16284. https://doi.org/10.7759/cureus.16284
Institute for Healthcare Improvement. (2022). Science of improvement: Establishing measures. http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementEstablishingMeasures.aspx
Niñerola, A., Sánchez-Rebull, M. V., & Hernández-Lara, A. B. (2020). Quality improvement in healthcare: Six Sigma systematic review. Health Policy, 124(4), 438-445. doi: 10.1016/j.healthpol.2020.01.002. Epub 2020 Feb 28. PMID: 32156468.