business

Running head: CARE IMPROVEMENT PROPOSAL 1

Milestone One: Care Improvement Proposal

Andrew J. Zink RN

Southern New Hampshire University

May 20, 2017

CARE IMPROVEMENT PROPOSAL 2

Care Improvement Proposal

Introduction

It is the aim of every healthcare provider to improve patient care with the main

objective of attaining a high degree patient satisfaction. It is important to create awareness

about healthcare among the public, increase better care demand, create more healthcare

regulation, and address malpractice litigation in order to achieve the change (McHugh & Ma,

2013). As a result, a fundamental requirement among the providers as well as the nurses and

physicians include quality training, competency of personnel, infrastructure quality, and

efficient operation systems. In the case of Long View Memorial Hospital, the intensive care

unit (ICU) is currently affected by various challenges including lack of coordination, poor

skills among some of the staff, and neglect. It is important that the issues are addressed in

order to avoid any mortality cases in the hospital.

Organization

The Long View Memorial Hospital is a healthcare provider owned by the Marley

Corporation and is accredited by the Joint Commission (TJC). The hospital provides various

healthcare services including medical and surgical procedures, urology, obstetrics, emergency

services, and orthopaedics. The leadership of Long View Memorial Hospital consists of

various positions including chief executive officer at the top, a chief nursing, financial, and

quality officers. All the leaders have their key roles in influencing the hospital activities. The

nursing staff at the hospital includes all degree graduates which shows their qualification for

medical services.

Improvement Opportunity

CARE IMPROVEMENT PROPOSAL 3

A major concern in the hospital is the deteriorating care of the patients. In the case

study, it is noted that most of the patients are readmitted for heart failure cases and

pneumonia which results in the penalization of the reimbursement in the service areas

(McHugh & Ma, 2013). Financial issues have also risen over time in the hospital due to the

fact that the more measures of the hospital have decreased over time from 93% to 87% which

has caused the existing performance improvement indicators to decrease by 5%. The

declining patient safety in the hospital has resulted in the poor financial management; since

many patients suffer from readmission and pneumonia cases, the hospital is currently

penalized in the diagnoses, thus, affecting the reimbursement procedures. As such, poor

quality of patient care in the hospital attributes to the low access to finance.

Purpose

There is a correlation between the experienced re-admission cases in the hospital and

the hospital nursing services within an organization. There is, thus, a need for increase in the

intervention the hospital offers in order to improve the quality of care provided in the hospital

(Clancy, 2004). Most healthcare providers currently utilize intensive, nurse-led, coordinated

healthcare management and health transitional models to reduce the cases of readmission.

Although the proposed programs may prevent readmission, they cannot provide effective

solution without considering the need to improve the nursing environment. A fundamental

change that should be adopted is the better working conditions and sufficient staffing

(Clancy, 2004). A hospital can become efficient if it has a good working environment as well

the employment of qualified nurses in order to formalize the organizational culture. Studies

also reveal that nurses who are qualified and have undergone post graduate programs

effectively influence the transition of the healthcare center while preparing the patients

continuously for discharge.

CARE IMPROVEMENT PROPOSAL 4

Proposal initiative

One of the methods that are effective in reducing re-admission of patients in the

hospital is the use of an intensive, coordinated care management model which targets the

improvement of care offered to the patients. This can be achieved through the recruitment of

enough nursing staff in the hospital. According to Pronovost et al. (2008), nurses who work

in a hospital that is well-staffed is able to provide discharge teaching to patients, a factor that

influences greatly the rates of readmission. In the case of The Long View Memorial Hospital,

by adding more registered nurses, the administration of the antibiotic prior to surgery will be

an easy work. With enough nurses to share the pre-surgery roles, there won’t be complaints

regarding increased workload among the nurses. This will improve the level of adherence

among the nurses.

An accommodating work environment should be considered with proper training and

updated technology to enhance performance of the hospital staff. According to Pronovost et

al. (2008), on average, the difference between heart failure readmission cases and good

working environments is 1.4% which almost equals the standard deviation of the rates of

readmission. If the conditions of a working environment improve to a better place, then

readmission rates should be expected to decline from 50th to 16th percentile. The American

Nurses Credentialing Center (ANCC) for instance, was invented in order to improve

motivation among nursing workers through the Magnet Recognition Program (Pronovost et

al., 2008). After its implementation, it was determined that the hospitals that achieved

recognition of the “Magnet” always achieved better patient outcome. As such, the Long View

Memorial Hospital may come up with a motivational program such as annual award

convention in which nurses who successfully participate in the improvement of the patients

after surgery are recognized. A competent staff can also be achieved through frequent

training of the employees. Hospitals are able to perform better if the employees are equipped

CARE IMPROVEMENT PROPOSAL 5

with necessary skills and knowledge. With the changing technology, it would also be

important to train the staff using the current technology introduced in the hospital as well as

the administering of the new antibiotic.

Leadership

The current leadership strategy that is evident at the Long View Memorial Hospital is

hierarchical which means that there are steps to be followed by the staff while reporting to the

leaders. As indicated, the executive C-suite reports to the CEO of the company, and the

nursing unit directors have to report to the Chief Nursing Officer. This form of leadership

might delay interaction among the stakeholders in the hospital (Clancy, 2004). In the case of

the rising re-admission among the patients, the hierarchical leadership might contribute to the

phenomenon due to the delayed reporting through the leadership ladder. The leaders have

also neglected the need to introduce enough staff in the hospital, and this has resulted in the

escalation of the problem.

The role of leadership is significant in embracing change. The leaders in the hospital

will have to work collaboratively in drafting the implementation plan. Various departmental

leaderships are able to offer various alternatives which can be used to address the issue of re-

infection of patients after surgery (Clancy, 2004). They could aid in coming up with

alternatives to influence surgeons accept the new intervention. In addition, most leaders can

easily influence their subordinates; collaborative efforts will, therefore, increase the

probability of adopting the change proposed.

CARE IMPROVEMENT PROPOSAL 6

References

McHugh, M. D., & Ma, C. (2013). Hospital nursing and 30-day readmissions among

Medicare patients with heart failure, acute myocardial infarction, and pneumonia.

Medical care, 51(1), 52.

Clancy, C. (2004). Improving patient safety-five years after the IOM report. The New

England journal of medicine, 351(20), 2041.

Pronovost, P. J., Berenholtz, S. M., Goeschel, C., Thom, I., Watson, S. R., Holzmueller, C.

G., ... & Hyzy, R. (2008). Improving patient safety in intensive care units in

Michigan. Journal of critical care, 23(2), 207-221.