Strategic Implementation of Quality Initiatives

Running head: EXECUTIVE SUMMARY 1

Deliverable Six: Executive Summary

LaToya T. Benson

Rasmussen University Online

Healthcare Quality Management

February 28, 2023

Dr. Dawn Ide

Purpose

Evidence-based medicine and quality improvement are the most used and essential terms in the healthcare system. Evidence-based practice refers to the care for specific patients by addressing questions relevant to systematic and operational performances to improve safety (Engle et al.,2021). In contrast, quality improvement refers to revising or building a new process using collected data from the target site to enhance the quality of healthcare outcomes. See the figure below:

Evidence-based practice is about translating existing evidence and applying it to clinical decision-making (Ginex,2023). The purpose of evidence-based practice is to utilize the best evidence available to make effective and realistically applicable decisions. The most effective and productive evidence for decision-making stems from research and literature. In clinical settings, clinicians and primary healthcare providers utilize opinions and study proposed by leaders and field experts to guide their practice.

Quality improvement initiatives are essential to patient care, including reducing medical errors, improving access to care, improving patient safety, and improving care coordination. These quality initiatives are essential to ensure that healthcare is being delivered to patients in an accurate and expected manner. Integrating quality improvement (QI) and evidence-based practice (EBP) into the healthcare setting can improve patient outcomes, increase quality, and reduce the cost of care. In a broader context, these can also apply to the practice's operational and logistical aspects (Grys,2022). As healthcare institutions become ever more complex and our focus on patient experience expands, nurses are leading and participating in  research studies, evidence-based practice (EBP) projects, and  quality improvement (QI) initiatives to improve patient outcomes (Ginex,2023).

EBP and QI have  subtle differences and frequent overlaps, making it challenging for nurses to identify the best option to investigate a clinical problem (Ginex,2023). For example, EBP is used to care for individual patients, address operational and systemic questions, or improve safety or quality outcomes. QI projects are used to fix or build a new process specific to the local practice and informed by local data and evidence from the literature. The purpose of QI projects is to  correct workflow processes, improve efficiencies, reduce variations in care, and address clinical administrative or educational problems (Ginex,2023). An example of a QI project is assessing and implementing urinary catheter removal policies to remove catheters within a defined timeframe. This report aims to compare EBP and QI processes and make recommendations to integrate the EBP into the QI initiatives.

Threats and Prevention

There are many barriers to implementing quality initiatives. These barriers include lack of funding, lack of staff training and resources, lack of support from management, lack of buy-in from clinicians, lack of leadership, poor communication, resistance to change and lack of data systems and analytics infrastructure (Barriers to quality improvement in healthcare, 2022). There are also many barriers to implementing patient quality initiatives. These barriers are lack of awareness, legal issues, demographics, and severity of illness (Importance of patient safety, 2020). Quality improvement is the framework used to systematically improve care. Quality improvement seeks to standardize processes and structure to reduce variation, achieve predictable results, and improve outcomes for patients, healthcare systems, and organizations.

Quality improvement processes can prevent these threats by using quality improvement methodologies such as the Lean Six Sigma (Advance in healthcare with Lean Six Sigma, 2021). The Lean Six Sigma is defined as a fact-based, data-driven philosophy of improvement that values defect prevention over defect detection. Lean Six Sigma methodologies are critically important in healthcare because they can reduce defects that can result in medical errors (Advance in healthcare with Lean Six Sigma, 2021). See the figure below:

When applied correctly, this methodology can lead to happier customers and increased revenue. In the healthcare industry, defects can affect revenue and customer satisfaction, which can also mean the difference between life and death. Using Six Sigma to improve healthcare quality can:

· Shorten wait times in hospitals and private practices-

· Prevent falls and injuries in hospitals and nursing homes.

· Reduce medication errors when prescribing and administering drugs or filling prescriptions.

· Increase turnaround time for lab results.

For example, to improve and shorten emergency room wait times, the organization must first define the problem(s). Second, measure the current check-in process and gather data for each step. Third, analyze the data collected from each stage, looking for elements and identifying the root cause. Fourth, develop and test solutions to improve check-ins. Fifth, Ensure the new check-in procedure stays on course by frequently monitoring and documenting.

Recommendations

Integrating evidence-based practice into quality improvement initiatives would help make literature-informed decisions and integrate effective strategies. The evidence-based practice incorporates the latest and best available literature evidence to address a patient's unique values and preferences EBP (Assmairan et al., 2021). Integrating EBP into quality improvement initiatives is crucial because of innumerable benefits. It will enable healthcare organizations to build a vital infrastructure by standardizing nursing practices and improving clinical patient care outcomes EBP (Assmairan et al., 2021). Also, address patient safety concerns by managing all the possible threats. Therefore, it is recommended that for the successful integration of EBP in clinical settings into quality improvement initiatives, it should be part of nurse education and training from the start EBP (Assmairan et al., 2021). It is also implemented in healthcare organizations to achieve tangible positive outcomes.

Strategic Plan

This plan will provide strategic direction for all stakeholders in improving patient safety in their practice domain through policy actions and implementing recommendations at the point of care. Patients are drivers of healthcare organizations. Therefore, the organization should prioritize its preferences. The selected quality improvement model is Lean Six Sigma. The Lean Six Sigma model identifies and prioritizes problems based on customer needs. This model aims to control and understand variations in an organization's processes. Healthcare organizations can use this model to prioritize required problems and the effectiveness of proposed initiatives to address those problems. Patient safety issues are the priority of this strategic plan. To enforce the Lean Six Sigma Model, a group of trained healthcare professionals must identify issues and propose practical solutions. The Lean Six Sigma approach is intensive because it requires time and effort.

Mission 

           The mission of this quality improvement model is to improve patient safety by eliminating barriers and threats existing in healthcare organizations.  

Vision 

           The vision of this quality improvement model is to maintain a patient-centered culture within the organization to enhance patient satisfaction and improve patient care outcomes. 

Goals/Objectives 

           The organization aims to maintain a positive healthcare culture in which nurses and healthcare practitioners are knowledgeable and aware of individual patient needs to enhance their satisfaction. By implementing this model healthcare preferences of patients would be met. 

SWOT Analysis

Strengths · Has A Proactive Approach · Customer Driven · Improves customer satisfaction. · Helps in avoiding waste · Offers Quality Certification (Cernjava,.n.d.)	Weaknesses · Extremely costly. · Requires huge amounts of statistical data. · Difficult implementation · Total participation is required. (Cernjava,.n.d.)
Opportunities · Reduce the likelihood of errors. · Increase Effectiveness · To determine the outputs or features that must be correct to satisfy the customer. (Cernjava,.n.d.)	Threats · Lack of consistent training · Lack of Organization · Loss of Transparency · there is a gap between the relity of a situation  (Cernjava,.n.d.)

References

Assmairan, K., Obeidat, R., & AbuAlrub, S. (2021). Evidence-based practice beliefs and implementations: a cross-sectional study among undergraduate nursing students. BMC Nursing, 20(2). https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-020-00522-x

Černjava, I. (n.d.). Advantages & disadvantages of Six sigma methodology. LinkedIn. Retrieved March 2, 2023, from https://www.linkedin.com/pulse/advantages-disadvantages-six-sigma-methodology-igor-cernjava#:~:text=The%20main%20advantage%20of%20Six,customer%20is%20considered%20a%20defect.

Engle, R. L., Mohr, D. C., Holmes, S. K., Seibert, M. N., Afable, M., Leyson, J., & Meterko, M. (2021). Evidence-based practice and patient-centered care: Doing both well. Health care management review, 46(3), 174–184. https://doi.org/10.1097/HMR.0000000000000254

Ginex, P. K. (2023, January 13). The difference between quality improvement, evidence-based practice, and research. ONS Voice. Retrieved February 27, 2023, from https://voice.ons.org/news-and-views/oncology-research-quality-improvement-evidence-based-practice.

Importance of patient safety. Maryville Online. (2020, November 6). Retrieved March 1, 2023, from https://online.maryville.edu/blog/importance-of-patient-safety/.

Grys, Crystal A. MSN, RN. Evidence-based practice, quality improvement, and research: A visual model. Nursing 52(11):p 47-49, November 2022. | DOI: 10.1097/01.NURSE.0000889812.89287.45

Purdue University. (2021, November 3). Advance in healthcare with Lean Six Sigma - LSS Online - Purdue. Lean Six Sigma Online Certification & Training at Purdue University. Retrieved March 1, 2023, from https://www.purdue.edu/leansixsigmaonline/blog/healthcare-advancement-with-lean-six-sigma/.

Quality Gurus. (2022, July 30). Barriers to quality improvement in healthcare. Quality Gurus. Retrieved March 1, 2023, from https://www.qualitygurus.com/barriers-to-quality-improvement-in-healthcare/#:~:text=These%20include%20lack%20of%20funding,data%20systems%20and%20analytics%20infrastructure.