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Assignment: Data Analysis and Quality Improvement Initiative Proposal

Assignment: Data Analysis and Quality Improvement Initiative Proposal

 

Quality improvement is the process followed to analyze the performance of an organization as well as efforts to improve performance (Dixon-Woods & Martin, 2016). Quality improvement programs are important because they result in improved outcomes for patients, enhanced staff efficiency and reduced waste linked to process failure. Hospitals handle lives and thus specific standards have to be met since even government and insurance reimbursement for patient care follows the health outcomes instead of procedures undertaken. Any quality improvement program should ensure that improvements are seen in areas like safety, effectiveness, access and patient-centeredness approach.  The purpose of this paper is to analyze data from Washington Hospital to establish a health care issue or area of concern, come up with a quality initiative proposal following the established health issues and supporting data analysis, integrate inter-professional perspectives to optimize safety, cost-effectiveness and work-life quality and apply effective communication strategies to enhance inter-professional care.

Washington Hospital always strives to meet the Institute for Healthcare Improvement recommendations, which are improved patient experience, improved population health and reduced cost of health care. WH is a 341-bed, acute care hospital that offers full range of care services and advanced medical technology and it was among America’s 100 best hospitals. The ratings are obtained from data collated from various departments and some of the quality indicators used are 30-day readmission rates, pain control, fall rate, and discharge information. 30-day readmission rate is selected because it ensures that the hospital has an incentive to enhance care coordination and communication and caregivers and patients are involved in post-discharge planning. The rates are also used by CMS to penalize hospitals whose rates are beyond the national standard. Actually any hospital with a high readmissions rate gets a 3% deduction in their Medicare payment (Wasfy et al., 2017). The discharge planning helps in reducing readmissions rates and at the same time helps in enhancing patient satisfaction with nursing care. Discharge planning offers tech back and post-discharge care information to the patients which enhances trust and self-management. The fall rates are calculated to reduce serious complication likes intracranial bleeds and fractures and ensure that patient safety within the hospital is optimized.

Data Preview

The unit managers at Washington Hospital closely follow patient outcomes and quality indicators. The unit managers ensure that all the practitioners are updated on the progress during the monthly staff unit. The last report that was generated indicated a remarkable improvement in all the four indicators; 30-day readmission rates, pain control, falls and discharge information as outlined in table 1 below.

Table 1.

Washington Hospital Performance Report 2018-2019

Year     30-day readmission rate (target)    Discharge information (target)    Pain control                (target)         Falls (target)
2018              11.2 %                  (11.6%)                80.5%               (90.6%)                60.1%             (70.7%)            50      (0)
2019              9.4%                     (9.4%)                  85.3%               (90.6%)                66.2%             ( 70.7%)           40      (0)

 

 

As indicated in Table 1 above, the hospital has seen a reduction in the 30-day readmission rates since in 2018 the rates were 11.2% while in 2019 they have reduced to 9.4% as per the current month of the year. The reduced rates can be linked to the increased percentage in the amount of discharge information offered which currently stands at 85.3 % from 80.5% in 2018. Pain management is also used as an indicator of patient satisfaction and better scores motivate patients to come back for other services ad refer their family and friends to the hospital. The hospital target is 70.7% and the current score is 66.2%. Although it is an improvement from the previous score of 60.1%, the hospital still has a long way to meet the set targets. Additionally, the hospital fall rates are below the set mark of zero rates since the falls experienced in 2018 were 50 while in 2019 they are 40.

Response to Data

Comparing the data generated in the two years, there is an improvement in pain control, discharge information, readmissions rates, and unassisted falls. Nevertheless, there is a need to come up with a quality initiative to ensure that the set targets are achieved. Using the information presented in the hospital performance report, all inpatient unit managers were requested to schedule meetings with nursing and auxiliary staff to analyze the reason why the set targets have not been achieved and come up with QI initiative that can enhance the outcomes. From the discussion, all nurses agreed that although there was an improvement in most of the indicators, the most affected part was the fall rates. The efforts already in place which is the use of call lights seem to stall the reduction process and the unit managers proposed that the quality initiative required should target the fall rates and ensure that the zero rate target set is achieved.

 

Quality Improvement Initiative Proposal

Intentional Rounding

There was an unanimous agreement that the quality initiative should help in handling fall rates. Patient fall rates are normally calculated using the number of fall events per 1000 patient days and the score indicates how a hospital maintains patient safety (Hicks, 2015). The initiative proposed was that the clinical nurse leader establishes an inter-professional team to implement a project that increases the day between patient fall events. The solution forwarded was enhancement of intentional rounding process and addressing the basic needs of the patients.  The project is borrowed from the AHRQ guidelines that postulate that intentional rounding is effective when targeting to reduce patient falls within a hospital (AHRQ, 2019). Hourly rounding helps nurses address patient needs like personal belongings, pain, position, and toileting needs. Research also outlines that the use of intentional rounding minimizes the use of call lights among the patients, enhances patient satisfaction and reduces patient falls within the hospital setting (Jenko, Panjwani & Buck, 2019). Additionally, intentional rounding is defined as a structured approach where a nurse assesses patients at specific times to meet their fundamental needs. Intentional rounding follows six steps which are introducing oneself, expectations setting, questioning patient needs, using the 4 P’s which are positioning, placement, pain, and personal needs, offering the patient needs and documenting the care offered. Intentional rounding, therefore, offers patient-centered care which not only decreases patient risk evens but also enhances patient satisfaction.

Implementation Plan

To help in implementation, the project team established the root causes of fall events in the unit. The proactive risk assessment was used to establish the causes of falls within the hospital. The expected areas that may present as problematic are inconsistent intentional rounding, unreliable fall risk assessment, absence of an effective hand-off communication of high-risk patients and poor reports on falls data and event to frontline staff (Jenko, Panjwani & Buck, 2019).  From the assessment, the team realized that the hospital had inconsistent intentional rounding.

The team then decided to use the plan-do-study-act (PDSA) cycle to test changes seen in the hospital. The changes were to be assessed

Assignment Data Analysis and Quality Improvement Initiative Proposal

Assignment Data Analysis and Quality Improvement Initiative Proposal

by measuring the current state of the fall events, analyzing and discovering fall causes, coming up with targeted solutions and lastly sustaining and spreading improvements. The project team came up with a visual cue laminated poster aimed at reminding the patients to request for assistance before visiting the bathroom or standing up. A daily monitoring tool was set to help in capturing data on the usefulness of the poster and a falls prevention brochure created to educate patients and families about falls.

 

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Although the AHRQ guidelines propose a multi-intervention approach, the hospital will adopt only two interventions, which are standardizing the intentional rounding and training patient and family on how to prevent falls (AHRQ, 2019). The project team expects that a standardized intentional rounding will reduce the fall rates to zero and it will handle toileting issues which are the major cause of the falls within the hospital. The unit leaders will have to also do their own rounding to assess how the nurses are communicating with patients and families on fall prevention. The unit leader will use a leader rounding tool to monitor the compliance levels of the unit staff.

Initiative Evaluation

The initiative will be analyzed by taking a baseline and current fall data obtained from the hospital quality database. Every fall event will be recorded and day between falls analyzed and then an analysis executed to monitor the changes in percentages of fall risk (Hicks, 2015). Every unit will have champions mainly a nurse and patient care technician who will be trained on how to fill the data collection form and execute the new work process. The nurse leader rounds will assist in assessing the staff competencies on patient rounding. The data obtained will then be analyzed by the project team and then a decision will be made on whether to maintain the project, make changes or plan another quality initiative.

Inter-professional Perspective

Prevention of hospital falls is crucial because they are linked to liabilities, delayed rehabilitation, increased patient length of stay and greater care costs (Jenko, Panjwani & Buck, 2019). To enhance the effectiveness of any quality initiative, there is a need to have inter-professional collaboration. Interprofessional collaboration offers clarity of professional roles and responsibilities, effective teamwork, common vision and coordination of action plans (Lasater et al., 2016). In the current initiative, the hospital aims at reducing fall rates through a standardized intentional rounding. Generally, falls prevention is left to nurses however it is a complex issue that should be approached using multiple perspectives.

Roles and Responsibilities

The proposed initiative will adopt an interprofessional perspective where the hospital administrators will be responsible for creating a safety culture and support the implementation of research-based clinical practice. The physician will help in conducting careful assessment of patient history, balance and mobility, peripheral nervous systems, cognition and medication review (Lasater et al., 2016).  Physiotherapists, on the other hand, will test the function of the patients as well as the walking and balance abilities. The assessment will be used by the nurses to establish patient at greater risk of falls to ensure that rounding efforts are maximized around these patients.  A selected nurse and patient care technician from each will collect the data that will be used for monitoring the project while the clinical nurse leader will lead the team and asses staff compliance to the project.

Use of High-Reliability Organization Model in the Intervention

To ensure that every member executes their roles as expected, training will be held and a monthly meeting set to address any setback found and reinforce the best practices. The project will also be handled using HRO model whose focus is safe reliable performance (Padgett et al., 2017). The project team will build expectations in their roles, routines, and strategies. The expectations will ensure that they follow an order and can predict the outcomes surrounding patient falls. The model also imparts mindfulness that will empower the team to manage unexpected events. The team will be able to establish early warning signs and thus will offer timely response towards unexpected events.

Work-Life Balance for the Team

The initiative expects to reduce the fall rates within the hospital. However, the effects expected are reduced length of stay, lesser readmissions and increased hospital safety (Khalifa, 2019).The reduced fall rates will enhance the work-life balance of the team because reduced readmissions and reduced length of stay mean that the emergency department will not be overcrowded. Beds will be available for patients and physicians will be able to offer quality care to their patients. research indicates that high numbers of patient increases chances of making errors thus number of errors will reduce in the hospital. Once the project achieves its objectives, the team will have an increased feeling of belonging to an efficient work community.  The level of staff burnout will decrease which eventually will reduce staff turnover and enhance the overall productivity of the hospital (Khalifa, 2019).

Communication Strategies

Interprofessional communication occurs when team members communicate in a collaborative and responsible manner (Foronda, MacWilliams & McArthur, 2016). To enhance communication, good listening skills will be fostered as well as mutual respect for all team members. All members will be offered a chance to contribute and an environment where they feel comfortable to give constructive feedback will be created. Additionally, members will be expected to communicate clearly and offer sufficient information. Any information required will be presented in a timely manner and appropriate health care providers will be notified of the patient’s condition (Foronda, MacWilliams & McArthur, 2016). The members will be expected to be polite and respectful, respond to other team members and review notes from nurses and other health care professionals.

To ensure a standardized approach to communication, the Situation, Background, Assessment, Recommendation (SBAR) tool will be used. Any message will be prepared using the SBAR framework and the messenger will ensure that the recipient of the message has understood the information. The tool will be used to communicate patient fall risk factors and suggest intervention, change in patient status, fall occurrence and environmental concerns (Reuben et al., 2017). The tool was selected because it outlines standardized prompt questions in four sections that ensure that information shared is focused and concise. It reduces the need for repetition reducing occurrence of errors and prompts team members to develop information using the right level of detail.

Conclusion

An analysis of Washington Hospital reveals that it has improved in almost all the indicators although it has not achieved the set targets. An evaluation from the unit managers led to a decision of reducing the fall rates to hit the set benchmark of zero rates. The selected initiative was standardizing intentional rounding and educating patients and families. The project is to be executed by an interprofessional team and they will be using the SBAR tool as their communication tool.

Overview
Prepare an 8-page data analysis and quality improvement initiative proposal based on a health issue of professional interest to you. The audience for your analysis and proposal is the nursing staff and the interprofessional team who will implement the initiative.
\”A basic principle of quality measurement is: If you can\’t measure it, you can\’t improve it\” (Agency for Healthcare Research and Quality, 2013).
Health care providers are on an endless quest to improve both care quality and patient safety. This unwavering commitment requires hospitals and care givers to increase their attention and adherence to treatment protocols to improve patient outcomes. Health informatics, along with new and improved technologies and procedures, are at the core of virtually all quality improvement initiatives. The data gathered by providers, along with process improvement models and recognized quality benchmarks, are all part of a collaborative, continuing effort. As such, it is essential that professional nurses are able to correctly interpret, and effectively communicate information revealed on dashboards that display critical care metrics.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
o Competency 2: Plan quality improvement initiatives in response to routine data surveillance.
 Outline a QI initiative proposal based on a selected health issue and supporting data analysis.
o Competency 3: Evaluate quality improvement initiatives using sensitive and sound outcome measures.
 Analyze data to identify a health care issue or area of concern.
o Competency 4: Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work-life quality.
 Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work-life quality.
o Competency 5: Apply effective communication strategies to promote quality improvement of interprofessional care.
 Apply effective communication strategies to promote quality improvement of interprofessional care.
 Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
Reference
Agency for Healthcare Research and Quality. (2013). Preventing falls in hospitals. Retrieved from https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtk5.html#tiptop\\
Questions to Consider
As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.
Reflect on QI initiatives focused on measuring and improving patient outcomes with which you are familiar.
o How important is the role of nurses in QI initiatives?
o What quality improvement initiatives have made the biggest difference? Why?
o When a QI initiative does not succeed as planned, what steps are taken to improve or revise the effort?

Required Resources
MSN Program Journey
Please review this guide for your degree program. It can help you stay on track for your practicum experience, so you may wish to bookmark it for later reference.
Suggested Resources
The resources provided here are optional. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid. The Nursing Masters (MSN) Research Guide can help direct your research, and the Supplemental Resources and Research Resources, both linked from the left navigation menu in your courseroom, provide additional resources to help support you.
Capella Resources
Capella provides a thorough selection of online resources to help you understand APA style and use it effectively.
o APA Module.
Capella Multimedia
Use this media piece if you do not have access to dashboard metrics to complete the final assessment.
o Vila Health: Data Analysis | Transcript.
Quality Improvement Examples and Results
These resources explore the effectiveness and lessons learned from various quality improvement initiatives.
o Ohde, S., Terai, M., Oizumi, A., Takahashi, O., Deshpande, G. A., Takekata, M., . . . Fukui, T. (2012). The effectiveness of a multidisciplinary QI activity for accidental fall prevention: Staff compliance is critical. BMC Health Services Research, 12, 197.
o Berman, J., Nkabane, E. L., Malope, S., Machai, S., Jack, B., & Bicknell, W. (2014). Developing a hospital quality improvement initiative in Lesotho. International Journal of Health Care Quality Assurance, 27(1), 15–24.
These articles showcase examples of strategic QI projects.
o Nazir, A., Dennis, M. E., & Unroe, K. T. (2015). Implementation of a heart failure quality initiative in a skilled nursing facility: Lessons learned. Journal of Gerontological Nursing, 41(5), 26–33.
o Schoenfelder, S. L., Wych, S., Willows, C. A., Harrington, J., Christoffel, K. K., & Becker, A. B. (2013). Engaging Chicago hospitals in the baby-friendly hospital initiative. Maternal and Child Health Journal, 17(9), 1712–1717.
This resource evaluates a QI initiative based on a communication strategy.
o Wysham, N. G., Mularski, R. A., Schmidt, D. M., Nord, S. C., Louis, D. L., Shuster, E., . . . Mosen, D. M. (2014). Long-term persistence of quality improvements for an intensive care unit communication initiative using the VALUE strategy. Journal of Critical Care, 29(3), 450–454.
Benchmarks for Quality Indicators
These databases provide recognized benchmarks for quality indicators.
o Montalvo, I. (2007). The national database of nursing quality indicators. Online Journal of Issues in Nursing, 12(3), 1–11.
o The Joint Commission. (2017). National patient safety goals. Retrieved from https://www.jointcommission.org/standards_information/npsgs.aspx

• Assessment Instructions
Preparation
In this assessment, you will propose a quality improvement (QI) initiative proposal based on a health issue of professional interest to you. The QI initiative proposal will be based on an analysis of dashboard metrics from a health care facility. You have one of two options:
Option 1
If you have access to dashboard metrics related to a QI initiative proposal of interest to you:
o Analyze data from the health care facility to identify a health care issue or area of concern. You will need access to reports and data related to care quality and patient safety. If you work in hospital setting, contact the quality management department to obtain the data you need.
o You will need to identify basic information about the health care setting, size, and specific type of care delivery related to the topic that you identify. You are expected to abide by HIPAA compliance standards.
Option 2
If you do not have access to a dashboard or metrics related to a QI initiative proposal:
o You may use the hospital data set provided in the media piece titled Vila Health: Data Analysis. You will analyze the data to identify a health care issue or area of concern.
o You will follow the same instructions and provide the same deliverables as your peers who select Option 1.
Instructions
Analyze dashboard metrics related to the selected issue.
o Provide the selected data set in the proposal.
 Assess the stability of processes or outcomes.
 Delineate any problematic variations or performance failures.
o Evaluate QI initiatives on the selected health issue with existing quality indicators from other facilities, government agencies, and non-governmental bodies on quality improvement.
 Analyze challenges that meeting prescribed benchmarks can pose for a heath care organization and the interprofessional team.
o Outline a QI initiative proposal based on the selected health issue and data analysis.
 Identify target areas for improvement.
 Define what processes can be modified to improve outcomes.
 Propose strategies to improve quality.
 Define interprofessional roles and responsibilities as they relate to the QI initiative.
 Provide recommendations for effective communication strategies for the interprofessional team to ensure the success of the QI initiative. Briefly reflect on the impact of the proposed initiative on work-life quality of the nursing staff and interprofessional team.
o Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.
Note: Remember, you can submit all, or a portion of, your draft to Smarthinking for feedback, before you submit the final version of your analysis for this assessment. However, be mindful of the turnaround time for receiving feedback, if you plan on using this free service.
The numbered points below correspond to grading criteria in the scoring guide. The bullets below each grading criterion further delineate tasks to fulfill the assessment requirements. Be sure that your Quality Improvement Initiative Evaluation addresses all of the content below. You may also want to read the scoring guide to better understand the performance levels that relate to each grading criterion.
1. Analyze data to identify a health care issue or area of concern.
 Identify the type of data you are analyzing (from your institution or from the media piece).
 Discuss why the data matters, what it is telling you, and what is missing.
 Analyze dashboard metrics and provide the data set in the proposal.
 Present dashboard metrics related to the selected issue.
 Delineate any problematic variations or performance failures.
 Assess the stability of processes or outcomes.
 Evaluate the quality of the data and what can be learned from it.
 Identify trends, outcome measures and information needed to calculate specific rates.
 Analyze what metrics indicate opportunities for quality improvement.
2. Outline a QI initiative proposal based on a selected health issue and supporting data analysis.
 Identify benchmarks aligned to existing QI initiatives set by local, state, or federal health care policies or laws.
 Identify existing QI initiatives related to the selected issue, and explain why they are insufficient.
 Identify target areas for improvement, and define what processes can be modified to improve outcomes.
 Propose evidence-based strategies to improve quality.
 Evaluate QI initiatives on the selected health issue with existing quality indicators from other facilities, government agencies, and non-governmental bodies on quality improvement.
 Analyze challenges that meeting prescribed benchmarks can pose for a heath care organization and the interprofessional team.
3. Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work-life quality.
 Define interprofessional roles and responsibilities as they relate to the data and the QI initiative.
 Explain how you would you make sure that all relevant roles are fully engaged in this effort.
 Explain what non-nursing concepts would you incorporate into the initiative?
 Identify how outcomes to measure the effect of the intervention affect the interprofessional team.
 Briefly reflect on the impact of the proposed initiative on work-life quality of the nursing staff and interprofessional team. Describe how work-life quality is improved or enriched by the initiative.
4. Apply effective communication strategies to promote quality improvement of interprofessional care.
 Identify the kind of interprofessional communication strategies that will be effective to promote and ensure the success of this performance improvement plan or quality improvement initiative.
 In addition to writing, identify communication models (like CUS, SBAR) that you would include in your initiative proposal.
5. Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
6. Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.
Submission Requirements
o Length of submission: 8 double-spaced, typed pages, not including title and reference page.
o Number of references: Cite a minimum of five sources (no older than seven years, unless seminal work) of scholarly, peer-reviewed, or professional evidence that support your evaluation, recommendations, and plans.

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