Problem or Issue in Practice or Organization
After a number of reports on employee mishandling patients, the hospital decided to take action and develop a quality improvement proposal aimed at eradicating any damaging tendencies that may affect its productivity and overall duty of providing quality healthcare to all its patients. Patients had reported that the staff took too long to admit and direct sick patients to a doctor immediately on arrival, ER services were becoming too efficient and nurses had been reported to be lagging behind on patient treatments. As expected, these issues were affecting the hospital immensely with some even leading to costly lawsuits. The ensuing discussion delves deeper into the particular details of the quality improvement proposal to improve efficiency of staff.
Advancements in technology have spearheaded the rapid rise in healthcare quality; however, issues involving patients’ needs and quality improvement are still facing a number of problems. The hospital was in dire need of a quality improvement initiative based on the increasing reports on staff inefficiency. This main aims of the initiative was to provide safety, effectiveness, and efficiency. Healthcare improvement begins at its core, which is focus on the patient (Parry & Coly, 2018). Without the patient, there would no longer be a hospital or the need for any healthcare at all. Therefore, this model was developed to address patient safety, engagement, systems that support patient access and evidence-based provision of healthcare. The projected outcomes would be provision of better and compassionate care, safety to reduce patient and staff infections and patient engagement.
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Demonstration of Support from Previous Research
A number of hospitals in Japan have recently implemented quality improvement initiatives similar to this proposition. They used the 5S method, which translates to sort, set in order, shine, standardize, and sustain. These values are aimed at generating more productivity at the workplace by sustaining and advocating for cleaner and coherent workplaces (Kanamori, Shibanuma, & Jimba, 2016). Healthcare professionals have identified the 5S as a potential solution to the resource-deficient government healthcare. Nine quantitative studies were taken to compare the status before and after the implementation of the initiative. The focus was on workplace flow, daily routines and services provided. It recorded a rapid 70% decrease in negative reports and a 37% reduction in setup times. The model is currently being implemented in eight African countries.
James Melton and Fred Blind (Melton & Blind, 2016), undertook a study to identify the impact of a hospital-wide quality improvement initiative on Emergency Department throughput and crowding in a community hospital in Florida. The study analyzed the number of patients who were door-in to door-out in less than three hours and the number of patients who had left without being attended to in the same period. The analysis was redone after implementation of the initiative. The study suggested that a supported quality improvement initiative could make multilayer improvements in ED improvements. The third study done by Blauwet (Blauwet & Bell, 2018), indicated the importance of technology in QI and operational efficiency. Innovations in Sioux Falls, South Dakota had led to faster access to care, safer working environment, and better communication between patients and healthcare professionals.
Steps Necessary to Implement Quality Improvement Initiative
The first step involves identifying the affected Microsystems such as ER or wards. Focusing on smaller units can make the initiative more manageable since they allow staff to provide efficient and patient-centered care to patients. QI is a continuous process hence the next step should be to understand and implement the improvement cycle. The Plan, Do, Study, Act (PDSA) cycle is the most efficient way of obtaining valuable knowledge for the continual improvement process. The third step would be to develop goals action plans clearly stipulating the improvement goals, specific interventions and the available strategies. This should be in a written action plan. The team has to come up with goals for the improvement work. Possible strategies can be obtained by visiting conferences and through academic literature and media. The written plan should indicate the areas of focus, goals, required resources, possible barriers, and ways to measure progress. A calendar is also essential in tracking progress.
Any team that sets achievable goals should also implement ways to monitor the progress. Performance trackers are necessary to ensure that the initiative is actually working. These measures will be clearly elaborated in the proceeding section. The fourth step is testing and refining the actions on a smaller scale (Kanamori, Shibanuma, & Jimba, 2016). Small tests of change help in making incremental modifications create enthusiasm and accumulate evidence of implementation to urge workers on embracing the initiatives. The final stage is adopting the interventions and changes on a hospital-wide scale. The team should also identify and determine how to deal with any barriers that they may encounter. They should also communicate internally to prevent the changes from fading with time.
Evaluation of Quality Improvement
Evaluation is done with the intention of acquiring knowledge through systematic documentation of QI inputs, processes, and outcomes using quantitative and qualitative research methods to fully analyze data (Parry & Coly, 2018). These measures are aimed at testing how new practices might affect the delivery of quality healthcare and asses how much it is improving. Evaluation methods should also be communicated in detail to the workforce to prevent unprecedented rejections. Moreover, a feasible number of measures should be used to prevent overburdening the staff. Visual displays such as run charts are essential in monitoring the process improvement and redesign efforts. They can be done on a daily, weekly, or monthly basis. Dashboards can also be used for the same purpose. The evaluation team would thereafter analyze the data and prepare reports.
Identification of Variables, Hypothesis Test, and Statistical Test
Variables that may affect the QI initiative include climate for teamwork. Collaboration levels differ in every workplace. Some employees might be better tailored to working together as a team towards a particular goal (Shea & Turner, 2019). Individual perceptions on the implementation of QI may also affect the overall outcome of the initiative. Individuals might embrace or reject the intended changes. A hypothesis is essential in testing out the intended result of a QI. It is more of an experiment to test and collect information on the potential success of the QI. One Microsystems or unit of the hospital should be used to implement the hypothesis. If it succeeds, it may be implemented on a larger scale. A statistical test is used to analyze statistical data in a research study. A Statistical Process Control (SPC) can help in monitoring, controlling, and improving areas that may be facing issues.
References
Blauwet, J., & Bell, M. (2018). Technology's Role in Quality Improvement and Operational Efficiency. Frontiers of Health Services Management , 3-15. doi:10.1097/HAP.0000000000000026
Kanamori, S., Shibanuma, A., & Jimba, M. (2016). Applicability of the 5S management method for quality improvement in health-care facilities: a review . Tropical Medicine and Health , 21-44. doi:10.1186/s41182-016-0022-9
Melton, J., & Blind, F. (2016). Impact of a Hospitalwide Quality Improvement Initiative on Emergency Department Throughput and Crowding Measures. The Joint Commission Journal on Quality and Patient Safety , 533-542. doi:10.1016/S1553-7250(16)30104-0
Parry, G., & Coly, A. (2018). Practical recommendations for the evaluation of improvement initiatives. International Journal for Quality in Health Care , 29–36. doi:10.1093/intqhc/mzy021
Shea, C., & Turner, K. (2019). Contextual factors that influence quality improvement implementation in primary care: the role of organizations, teams, and individuals. Health Care Management Review , 261–269. doi:10.1097/HMR.0000000000000194
