Quality In Long-Term Care

1. Think about and do some independent research on recent publications that discuss quality improvement initiatives in healthcare settings that are having positive outcomes that are supported by data, benchmarks or staff/resident testimonies.

Health care is a complex, ever-changing system that requires health care professionals to be well educated and up to date on current policy regulations or reforms, new emerging technology, and quality improvement approaches. There are many different approaches to improve quality and lower costs, but health care facilities should first identify what specific areas they need to focus on improving the most. Establishing effective and sustainable performance improvement initiatives can help health care professionals evaluate the current level of quality and the desired level of quality. From there, they need to determine what quality improvement methodology to use. After doing much research, I found that the most common and productive quality improvement methodologies in health care are plan-do-study-act (PDSA) and six-sigma.

The most commonly used approach in health care is the PDSA cycle. It involves a four-step process to test a change by planning the test, trying it out, analyzing the results, and acting on what is learned from the test. One case that proved the PDSA cycle to be an effective improvement initiative was conducted by Prathibha Varkey with the intentions of enhancing medication reconciliation to ensure complete and accurate lists of medications within the continuum of care. The first cycle included creating a data collection form to assess patients medication use, then the second cycle was modified to prompt patient response to a list of medications from their most recent visit to the facility. The data collected by the end of the study proved that the use of the PDSA methodology decreased the average number of discrepancies from 5.24 to 2.46 (more than 50% less) and also increased the number of patient-reported medications from 47.3% to 92.6%.

Six-sigma is a rigorous statistical methodology and another quality improvement initiative that is designed to reduce costs, decrease process variations, and eliminate any defects or errors in the system. It is achieved through defining, measuring, analyzing, improving, and controlling the project. The first step includes defining the goals and scope of the project. A plan for data collection and measurement is then developed in the second step. The third step is when data analysis occurs. Implementation plans and solutions for improvement are developed in step four. In the final step, quality controls are developed to continuously monitor the new process. The Charleston Area Medical Center utilized six-sigma to assess and improve its rate of colon and vascular surgical site infections, and the data from the project proved the methodology to decrease the surgical site infection rate at their facility by 91% (2.86 sigma) and saved them more than $1 million in annual savings.

2.  Consider a situation where you are hired as manager of a healthcare facility with poor satisfaction ratings by staff and residents/patients.  In addition, your quality indicators show you are below the national average.

If I were hired as a manager of a healthcare facility that didn’t have good satisfaction ratings by staff members and patients and was ranked below the national average, I would implement the Plan-Do-Study-Act method as the main quality improvement initiative because it is a simple yet powerful tool for stimulating quality improvement. To begin implementation of the PDSA cycle, you need to ask “What are we trying to accomplish?”, “How can we determine that the change is an improvement?”, and “What changes can we make that will result in improvement?” Answering these questions can help healthcare professionals break down the process into steps, evaluate the outcome, make improvements, and then test it again. After 6 to 12 months of utilizing the PDSA cycle, health care facilities should have a continuous quality improvement process that they work together to maintain and further improve. An example could be that the facility introduced patient and physician surveys so that the healthcare organization can identify why their ratings are low and what they can do to increase patient and staff satisfaction. One way to measure the success of the quality improvement outcomes would be to compare the data from the previous ratings with the ratings of the facility after the patient/staff survey was introduced and change was implemented.