NUR 410 Midterm Review - Week 3 PDF

NUR 410 Midterm Review -- Week 3 ================================ **[Week 3 Learning Objectives ]** - *Describe quality improvement and how it can shape quality of care* - *Compare and contrast quality and quality improvement* - *Discuss the importance of team in quality improvement* -...

NUR 410 Midterm Review -- Week 3 ================================ **[Week 3 Learning Objectives ]** - *Describe quality improvement and how it can shape quality of care* - *Compare and contrast quality and quality improvement* - *Discuss the importance of team in quality improvement* - *Explain the Model for Improvement* - *Apply tools used in quality improvement* **What is quality in healthcare?** - **Equitable:** every patient received high quality care that is fair and appropriate to them, no matter where they live, what they have or who they are - **Effective:** care is based on the best available evidence and produces the desired outcome - **Patient centered:** patient autonomy in decision making is promoted, care reflected patient's preferences and goals - **Efficient:** waste is eliminated and efforts are made towards streamlining and coordinating care - **Timely:** patients receive the care they require within an acceptable wait time - **Safe:** people are not harmed by the system. Policies, processes, and procedures are in place. To ensure everyone's safety **What is quality improvement?** - **Quality improvement:** A systematic, formal approach to analyzing performance and efforts to improve performance - The goal is to continuously look for ways to improve the quality of an organization's outputs (e.g., products or services) and outcomes - **Steps include:** - Planning for change - Implementing change - Sustaining change **Forming a Team** - Teams are necessary for quality improvement work - Need diversity in the team members: - Different health professionals - Different areas & levels of expertise - Different perspectives on the problem - Engage people who will benefit from the problem being solved **QI Team composition** - Team lead: responsible for leading the project and making sure it gets fully carried out - Executive sponsor: work behind the scenes to ensure u have access to the resources needed to carry out the process - they vouch for the project and make sure it\'s aligned with strategic direction - Point of care staff and those who are familiar with the process (clinical or non clinical) - Patients/clients and families should be and are included: May want more than 1 patient so they feel comfortable speaking up **Team Size** - Big enough so that there are enough people to do the work (6-10 members = ideal) - Small enough to allow for: Effective communication, decision making, scheduling **Model for Improvement** 1. Plan: identify tasks, task owners, objectives, outcomes and implementation plan (what, when, where, who) 2. Do: put plan into action and record data 3. Study: evaluate data to see if plan is working 4. Act: adopt, adapt, or abandon intervention **Steps for applying the model for improvement: fundamental principles** 1. Know what you want to improve 2. Have a feedback mechanism in place to tell you if improvement is happening 3. Develop an effective change that will result in improvement 4. Test a change before you attempt to implement it 5. Know when and how to implement a change and make it permanent **Identifying Problems & Opportunities for Improvement** - **Patient perspectives --** patient complaints/feedback, or what would better look like to our patients? - **Staff perspectives --** what would better look like to our colleagues? - **Practice data --** how does our performance compare to others? OR to the ideal? - **Research evidence and guidelines --** is there new evidence that suggests we should change how we deliver care? New guidelines we should implement? **Clarifying the Problem** - A problem is a **gap** between the current and future state - Defined with problem statement - What is the problem? - Who is affected? When? - How long has the problem existed? - What is known about the problem (frequency, causes etc.) - What research and evidence exists? - What is the impact? - Must understand the problems because: - Having a clear understanding of the problem allows you to identify goals, potential solutions, and desired outcomes - Poor understanding of the problem can lead to inappropriate and/or ineffective solutions **Tools for Exploring the Problem** - **5 whys --** repeated cycles of asking "why" this is occurring, until arrive at root cause - state the problem, ask why \~5x, the final why is a cause you can address - **Fishbone diagram --** identify the contributing factors (cause and effect diagram) - **Process map --** map of the current process, helps to identify gaps - most frequently used to document and gain insight into a process - can be used to: - identify unnecessary steps/handoffs/time spent in existing programs/processes -- current state - create a shared understanding - map out the ideal process for a new program -- future state **Aim Statements need to be SMART:** - **Specific:** actionable & targeted - **Measurable:** from current to future state - **Achievable:** based on team member perspectives - **Relevant/Realistic:** patient-centered, impact potential - **Time-bound/Timely:** specific timeline for change **Change Concepts & Change Ideas** **Change Concept** **Change Ideas** --------------------------------- ----------------------------------------------------------------------------------------- **Eliminate waste** Eliminate equipment that is not useful, eliminate multiple EHR entries **Improve workflow** Minimize handoffs, find and remove bottle necks, change the order of steps in a process **Change the work environment** Give people access to information, conduct training, share risks **Listen to customers** Talk to or survey patients about their experiences **Error proof** Add in forcing functions, automate, reminders & alerts, visual cues **Factors impacting improvement** - Organizational culture - Lack of cohesive mission and vision - Inadequate infrastructure - Competing priorities - Dysfunctional external relations