Identify the type of data you are analyzing from your institution or from the Vila Health activity.
Explain why data matters. What does data show related to outcomes?
Analyze the dashboard metrics. What else could the organization measure to enhance knowledge?
Present dashboard metrics related to the selected issue that are critical to evaluating outcomes.
Assess the institutional ability to sustain processes or outcomes.
Evaluate data quality and its implications for outcomes.&
Examine the nursing process for variations or performance failures that could lead to an adverse event or near miss.
Identify trends, measures, and information needed to critically analyze specific outcomes.
Specify desired outcomes related to prevention of adverse events and near misses.
Analyze which metrics indicate future quality improvement opportunities.
Determine benchmarks aligned to existing QI initiatives set by local, state, or federal health care policies or laws.
Identify any internal existing QI initiatives in your practice setting or organization related to the selected issue. Explain why they are insufficient.
Evaluate external national or international QI initiatives on the selected health issue with existing quality indicators from other facilities, government agencies, and nongovernmental bodies on quality improvement.
Define target areas for improvement and the processes to be modified to improve outcomes.
Propose evidence-based strategies to improve quality.
Analyze challenges that meeting prescribed benchmarks can pose for a health care organization and the interprofessional team.
Define interprofessional roles and responsibilities relating to data and the QI initiative.
Explain how to ensure all relevant interprofessional roles are fully engaged in this effort.
Identify how outcomes will be measured and data used to inform interprofessional team performance related to specific tasks.
Reflect on the impact of the proposed initiative on work-life quality of the interprofessional team.
Describe how the initiative enhances work-life quality due to improved strategies supporting efficiency.
Identify interprofessional communication strategies that will help to promote and ensure the success of the QI initiative.
Identify communication models, such as SBAR and CUS, to include in your proposal.
SBAR stands for Situation, Background, Assessment, Recommendation.
CUS stands for “I am Concerned about my resident’s condition; I am Uncomfortable with my resident’s condition; I believe the Safety of the resident is at risk.”
Consult this resource for additional information about these fundamental evidence-based tools to improve interprofessional team communication for patient handoffs:
Agency for Healthcare Research and Quality (AHRQ). (n.d.). Module 2: Communicating change in a resident’s condition. https://www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/ptsafety/ltcmod2ap.html
https://media.capella.edu/CourseMedia/MSN6016/VilaHealthDataAnalysis/wrapper.asp
Runninghead: QUALITY IMPROVEMENT INITIATIVE PROPOSAL 1
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
Data Analysis and Quality Improvement Initiative Proposal
Learner’s Name
Capella University
Quality Improvement for Interprofessional Care
Data Analysis and Quality Improvement Initiative Proposal
Month, Year
Comment [JS1]: Good job with the
submission. It follows the rubric. For
the most part is written in scholarly
voice. The submission is clear and
concise. References and citations are
used to support your opinion and
position with relevant evidence.
Please see my tracked changes for
areas of revision.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 2
Data Analysis and Quality Improvement Initiative Proposal
I. Introduction
Health care professionals are constantly striving to improve the quality of care and safety
provided to their patients. The culture of care quality and patient safety depends on a strong and
supportive work environment that promotes leadership, evidence-based practice, effective
communication, and interprofessionalism. Nurse leaders play a crucial role in establishing this
culture and directly influence quality outcomes across an organization.
II. Problems and Needs
The role of nurse leaders in maintaining the quality in the nursing and clinical
departments is discussed using the example of TrueWill General Hospital (TGH), a
multispecialty hospital in the United States. As part of an annual assessment of organizational
quality, the hospital’s quality management office completed its analysis of dashboard metrics for
the surgical units for the year 2016–2017. The office released the data in its Quality and Safety
Report 2016–2017. The surgical units’ data included adverse events and near misses and used
four quality indicators: length of stay (LOS) exceeding 7 days, patient readmission rates, pain
level between 7 and 10 for more than 24 hours, and patients with pressure ulcers.
III. Proposed Solution
The results of the analysis showed that three quality indicators—pain levels,
readmission
rates, and pressure ulcers—performed below the hospital’s benchmarks (see Table 1 and
Appendix for data and descriptions of indicators and benchmarks). The connection between these
indicators and the services of the surgical units’ nurses will be discussed in this proposal for a
quality improvement initiative. The proposal will analyze the relational patterns between the
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 3
indicators and the data, identify assumptions governing health care quality and nursing
characteristics, determine methods to discover the root causes of quality issues, and recommend
a framework as well as strategies to improve quality outcomes in the surgical units.
Analysis of Dashboard Metrics to Identify Quality Issues
The patients who require round-the-clock perioperative care are admitted to TGH’s
surgical units, which are equipped for general, orthopedic, urologic, and ambulatory surgery. The
critical nature of patients admitted to these units makes quality and safety the units’ highest
goals. Quality and safety outcomes are regularly evaluated. The units are staffed by teams of
interdisciplinary professionals: physicians, nurses, therapists, dieticians, pharmacists, and
ancillary medical staff.
Table 1
Quality and Safety Report 2016–2017
Unit – Year
LOS
exceeding 7
days
Patient
readmission
Pain level
between 7 and
10 for more
than 24 hours
Patients with
pressure
ulcers
Total
Surgical
2015
43 29 15 14 101
Surgical
2016
31 43 30 25 129
The data available from the Quality and Safety Report in Table 1 revealed that the
annual patient readmission rates increased from 29 incidents in 2016 to 43 in 2017. Similarly,
the number of patients who experienced pain for more than 24 hours without relief doubled
from 15 in 2016 to 30 in 2017. Pressure ulcers, a common quality and safety issue in surgical
patients, also increased to 25 from 14 in 2016. Conversely, the units reported a drop in the
number of patients whose LOS exceeded 7 days—from 43 in 2016 to 31 in 2017.
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 4
The outcomes are a cause for concern because they can affect the hospital’s
stakeholders—the patients, health care professionals, and the organization—in various ways.
Patient readmissions are a costly outcome for TGH because the Patient Protection and Affordable
Care Act, through its Hospitals Readmissions Reductions Program, financially penalizes
hospitals with higher than expected readmissions (Bartel, Chan, & Kim, 2014). Hefty penalties
are enforced because readmissions are thought to be the result of poor follow-up care (Abelson,
2013).
Furthermore, studies have found an association between LOS and the risk of
readmissions. Bartel et al. (2014) reviewed prior literature on the impact of decreasing patient
LOS and increasing readmission rates and concluded that a patient who stays for an additional
day may reach a higher level of stability. At TGH, health care professionals may have faced
immense pressure to reduce patient LOS to control per capita health costs. The pressure could
have forced the units’ nurses and doctors to rush through patient care plans and hasten the
process of educating patients regarding post-discharge behavior. Furthermore, patients who are
readmitted may lose trust in the ability of their health care providers to provide complete and
quality care.
Just as readmissions are a quality issue that affects all stakeholders, high pain levels and
pressure ulcers affect the surgical units’ nurses and patients. This inference is based on the theory
of nurse-sensitive patient outcomes, which explains that pain and pressure ulcers are patient
outcomes that depend on the quantity and quality of nursing (Stalpers, de Brouwer, Kaljouw, &
Schuurmans, 2015). Based on this inference, it can be assumed that there could be issues in the
performance and quality of nursing in TGH’s surgical units.
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 5
Moreover, there is evidence linking pressure ulcers and postoperative pain to a higher
risk of readmissions (Kirkner, 2017; Lyder et al., 2012). While TGH’s data do not directly link
pressure ulcers and pain to readmission rates, it is possible to theorize that reducing pressure
ulcers and pain in patients will also reduce readmissions. Therefore, the surgical units’ nurses can
help prevent readmissions by preventing ulcers and managing pain in patients more efficiently.
The standard of nursing quality is an important predictor of favorable quality outcomes.
Based on the analysis of the data in the report, TGH’s nurse leaders met with the units’ nurses to
examine the nursing factors that contributed to the unfavorable outcomes. The nurse leaders
identified the problem to be the transactional leadership style practiced by the perioperative
charge nurses. Transactional leadership is defined as an exchange relationship that clearly
distinguishes the follower from the leader and is focused on the contingent reward system with
individuals being rewarded or punished based on their performance (Thomas, 2016).
Transactional leadership may have become the dominant style of leadership in TGH’s surgical
units because of the lack of training and incompetence among nurses. The nurse leaders decided
to change the leadership style of charge nurses with a quality improvement (QI) initiative based
on the data analysis. The proposal for the QI initiative will identify an ideal leadership style and
propose strategies to implement the style. Knowledge gaps or areas of uncertainty that require
further evaluation will also be discussed in the proposal.
Outline for the Quality Improvement Initiative Proposal
Charge nurses occupy a frontline position in influencing the staff engaged in patient care
(Thomas, 2016). They are responsible for functions such as coordinating and evaluating nurse
staffing plans, balancing unit budgets, and making patient assignments. However, the
transactional leadership at TGH was ineffective because the charge nurses were not skilled
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
Comment [JS2]: This reference is
too old to be viable for relevant
evidence-based practice. In health
care, it is important to use up-to-date
references that are not more than 5
years old. I might suggest finding a
more recent reference.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 6
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
enough to notice nurse dissatisfaction, prevent conflicts and competition among the nurses, or
establish effective communication channels. The surgical units’ nurses were not given any
guidance by the charge nurses on accomplishing quality improvement tasks or participating in
collaborative and interprofessional efforts. Because of the transactional leadership’s tendency to
reward or punish staff based on performance (Thomas, 2016), the nursing staff paid more
attention to accomplishing tasks such as discharging patients quickly than to ensuring patient
satisfaction.
The QI initiative will provide strategies that support the transition from transactional to
transformational leadership. Transformational leaders focus on internalizing ethical and
professional values in their team members and assist in aligning those values with organizational
goals. A transformational leader’s optimism, selfless service, and creativity motivate and
encourage teams. It is worth noting that the motivational and inspirational aspects of
transformational leadership will significantly change the work environment and the nurses’
commitment to the organization (Thomas, 2016).
The quality improvement model that is best suited to introduce and implement
transformational leadership is the Plan-Do-Study-Act (PDSA) model. Hence, the model will
serve as the framework for the QI initiative. The model is effective when there is a need for
accelerated change, as in TGH’s case. The four steps of the framework can effect systemic
change that will promote long-term improvement and implementation of the initiative on a larger
scale. Various strategies incorporated into the PDSA steps will be discussed briefly (Thomas,
2016). 1. Plan: This step involves setting up an interdisciplinary team. While the nurse
leaders already identified the problem to be transactional leadership through
discussions and the analysis, the interprofessional team will validate the previous
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 7
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
results using a Multifactor Leadership Questionnaire survey. The survey will be
distributed to the nurses as well as other perioperative health care professionals.
After the results of the survey are analyzed, the team will define achievable goals
such as establishing a transformational leadership style and improving the
affected quality indicators.
2. Do: In this step, the team, with support from the organization, will create a
strategic plan to achieve the defined goals. Examples of strategies include
introducing training modules for leadership development and quality and safety
education.
3. Study: The results from the implementation of strategies devised in the previous
steps are analyzed. Observations are based on different interprofessional
perspectives and are set against the performances of TGH’s surgical units, not just
nursing.
4. Act: In the final step of the PDSA model, the goals set in step one are reevaluated
to determine whether the strategies were effective. TGH can carry out the step by
calculating data on the four quality indicators and noting increases or decreases in
the quality outcomes. Based on that evaluation, the PDSA cycle is deemed
complete or renewed with new goals and strategies.
Despite the effectiveness of the PDSA model, knowledge gaps and areas of uncertainty
may still affect the QI process. First, the use of just four indicators to measure quality outcomes
in the surgical units can give a partial or narrow understanding of the issues. Further evaluation
should be done using indicators such as mortality and patient satisfaction and nurse-sensitive
indicators such as nurse perception of job and level of nursing education.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 8
Secondly, the data only shows problems affecting the hospital’s surgical units.
Foundational theories such as systems theory explain how problems in one part of the
organization affect performance and quality outcomes in other parts. However, there is a lack of
data on quality issues from other departments at TGH that could be connected to the issues seen
in the surgical unit. Therefore, the team spearheading the QI efforts can take steps to include data
from other units and departments to create a comprehensive QI initiative. Another area of
uncertainty is the studies connecting nursing leadership and patient outcomes. Most studies do
not test whether nursing leadership directly improves patient outcomes; they merely analyze the
connection conceptually. Understanding the relationship between leaders and patient outcomes
requires interventions and longitudinal studies with continuous observations (Wong, 2015).
To achieve better patient outcomes by changing the nursing leadership, the proposed QI
initiative will be guided by various interprofessional perspectives. The perspectives will support
patient safety, cost-effectiveness, and work-life quality for nurses and other units’ staff. Each
perspective will address an aspect relevant to TGH, such as leadership and teamwork. The
discussion will also identify assumptions that highlight the importance of these perspectives.
Integration of Interprofessional Perspectives That Support Quality Improvement
Over the years, efforts to improve health care quality and safety drew inspiration from
various interprofessional perspectives. The perspectives important to TGH are leadership theory,
systems theory, and collaborative relationships. The identification of these specific perspectives
and their integration into the hospital’s QI initiative are based on assumptions made on the
factors that influence patient outcomes.
One assumption is that health care systems are interconnected and problems in one unit
or department can affect other parts of the system (Huber, 2017); problems in the surgical units
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 9
can affect the quality of other hospital departments. When quality is compromised in multiple
departments, the organization will be unable to function properly and achieve its goals of
providing quality and safe care for patients. Poor nursing performance and quality also affect the
performance of doctors, therapists, pharmacists, dieticians, and other interdisciplinary
professionals working in the surgical unit. These health care professionals work alongside nurses
and depend on them to carry out care plans effectively, quickly, and cost-effectively.
Another assumption is that nurse leaders such as charge nurses can learn and develop
leadership attributes (Thomas, 2016) that will help them improve their leadership style.
However, leadership development can only take place if the organization is supportive and
allocates appropriate resources and facilities. The third and last assumption guiding the
conceptual basis of the initiative is that anyone—not just executives or managers—can practice
leadership (Smith-Trudeau, 2016).
The main theme explored in these assumptions is leadership; it is an important systems
theory factor and collaborative relationships are influenced by leadership styles. Although the
connection between leadership and patient safety needs to be further evaluated, experts agree that
certain leadership styles obtain better results than others do. In particular, experts have compared
the effectiveness of transactional leadership to transformational leadership in achieving patient
safety. Transactional leadership, as was observed in TGH, is ineffective, as it focuses on rewards
rather than outcomes. Conversely, transformational leadership engenders a higher level of
competence that helps in guiding and motivating team members to follow a higher level of ethics
and evidence-based care, thereby improving the outcomes for patients (Thomas, 2016).
Transformational leaders are also more competent when introducing cost-reduction plans while
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
10 QUALITY IMPROVEMENT INITIATIVE PROPOSAL
maintaining quality in their units. They are more skilled than transactional leaders at
organizational and administrative management, which is an essential skill for budgeting.
Transformational leadership is also the preferred leadership strategy in implementing
systems theory approaches. Systems theory is important in QI, as it focuses on understanding
root causes and symptoms of quality and performance problems (Huber, 2017). By
understanding latent causes of quality issues, TGH can focus on proactive quality measures that
prevent quality and safety issues in the long term. Such approaches are known to be cost-
effective and sustainable.
Transformational leadership’s focus on people through effective interpersonal
relationships and charismatic influence is also beneficial for establishing collaborations among
teams and developing optimum work-life quality for staff. The surgical units at TGH, consisting
of interprofessional staff, depend on a sense of shared goals among staff. The nurses are the
largest staff group in the surgical units and issues within their workforce such as nonalignment
of goals affect other units’ staff. Transformational leaders are capable of guiding nurses in
building respectful and positive relationships with their colleagues.
These interprofessional perspectives will act as guides for the QI team as they implement
the PDSA steps. The perspectives are especially useful in facilitating open and transparent
communication. The QI proposal will suggest communication strategies that are imperative
when expanding the proposal into a full-fledged QI program. The proposal will also provide
assumptions that will guide those suggestions.
Effective Communication Strategies to Promote Quality Improvement
Communication is a key leadership duty and facilitates the smooth functioning of different
organizational systems (Huber, 2017). Without effective communication methods,
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 11
leaders will not be able to convey organizational goals and decisions or implement QI changes.
At TGH, the charge nurses could not communicate care plans to their nursing staff or coordinate
with other units’ leaders and interdisciplinary professionals to achieve ideal outcomes. Their
ineffective communication methods also set a bad example for the nursing staff, who look to
their leaders for guidance and instruction.
Therefore, it is important to develop communication strategies before the QI strategies
are implemented. Well-defined communication channels will promote interprofessional efforts in
patient care and quality improvement. The assumptions guiding the strategies are as follows: (a)
Leaders facilitate and mediate effective interprofessional collaborations in care delivery, which
can only happen if the leaders are competent in communication skills; (b) Quality improvement
is a resource-intensive effort, but coordinating and utilizing those resources requires open and
honest communication among organization, patients, and interprofessional staff; (c) Nursing
autonomy in decision making is important for improving the performance of nursing staff, but
autonomy is a product of mutual respect and effective communication among all
interprofessional staff, including management and administrative staff.
Based on these assumptions, a few communication strategies to implement the QI
initiative and promote interprofessional care or teamwork are recommended. The strategies are
as follows: (a) training the QI team in verbal, nonverbal, written, and electronic means of
communication, which will improve relations within the team and will be useful during
interprofessional collaborations; (b) setting up team documentation, where all team members
will enter details of ideas, meeting minutes, and QI-related data; during the Do stage of the
PDSA, team documentation will be implemented at the unit level and all staff present during a
patient visit will enter details into the patient record, assist with order entry, and
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 12
process prescriptions (Bodenheimer & Sinsky, 2014); (c) setting up a weekly QI team meeting
where team members will receive a copy of the agenda in advance and provide feedback on
meeting goals; post-meeting, members will be sent copies of all communication via e-mail to
maintain transparency (Thomas, 2016); and (d) briefing units’ staff on decisions made in these
meetings and, when needed, e-mailing summaries of the meeting minutes to all staff members so
specific groups or individuals will not feel excluded from the QI efforts.
As the QI process progresses, the team can add more communication strategies into the
PDSA model or make improvements to the existing strategies. After all, the PDSA model for
quality improvement was selected because it allows experimentation, quick pilot testing of plans,
and implementing the plans on a larger scale after analyzing the results (Thomas, 2016). The
onus of organizing and coordinating the QI efforts falls on the nurse leaders heading the team.
They must develop their leadership competency to inspire similar changes in the charge nurses.
IV. Conclusion
Data- and outcome-driven organizations must constantly analyze their quality indicators
and implement changes that improve all clinical and organizational outcomes. Quality and safety
evaluations, such as the one conducted at TGH, often reveal hidden issues that are influencing
patient outcome negatively, such as ineffective leadership styles. Leadership is important in
uncovering the latent problems and implementing changes that improve quality and safety.
However, as displayed at TGH, leadership itself depends on factors such as interprofessional
care and teamwork, communication, and highly qualified health care professionals. The absence
of these factors can affect patient outcomes drastically. Understanding this interdependence
among organization, leadership, and staff is key to high-quality performance and patient safety.
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 13
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
References
Abelson, R. (2013, March 29). Hospitals question Medicare rules on readmissions. The New York
Times. Retrieved from http://nytimes.com/2013/03/30/business/hospitals-question-
fairness-of-new-medicare-rules.html
Bartel, A. P., Chan, C. W., & Kim, H. (2014, September). Should Hospitals Keep Their Patients
Longer? The Role of Inpatient and Outpatient Care in Reducing Readmissions (Report
No. 20499). Retrieved from the National Bureau of Economic Research website:
http://nber.org/papers/w20499
Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires
care of the provider. Annals of Family Medicine, 12(6), 573–576. Retrieved from
https://ncbi.nlm.nih.gov/pmc/articles/PMC4226781/
Huber, D. L. (2017). Leadership and nursing care management (6th ed.) Philadelphia: W.B.
Saunders. http://dx.doi.org/10.7748/nm.21.6.13.s14
Kirkner, R. M., (2017, May 7). Postop pain may be a predictor for readmission. ACS Surgery
News. Retrieved from http://mdedge.com/acssurgerynews/article/137637/pain/postop-
pain-may-be-predictor-readmission
Lyder, C. H., Wang, Y., Metersky, M., Curry, M., Kliman, R., Verzier, N. R., & Hunt, R. H.
(2012). Hospital‐acquired pressure ulcers: Results from the national Medicare patient
safety monitoring system study. Journal of the American Geriatrics Society, 60(9), 1603–
1608. Retrieved from http://henlearner.org/wp-content/uploads/2012/03/hospital-
acquired-pressure-ulcers
Smith-Trudeau, P. (2016). Nursing leadership at all levels: The art of self-leadership. Vermont
Nurse Connection, 19(4) 4–5. Retrieved from
Comment [JS3]: I would suggest
locating a more recent reference.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 14
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
http://web.a.ebscohost.com.library.capella.edu/ehost/pdfviewer/pdfviewer?vid=1&sid=63
1c6937-3dbc-466d-ba31-b5e5aec17013%40sessionmgr4010
Stalpers, D., de Brouwer, B. J. M., Kaljouw, M. J., & Schuurmans, M. J. (2015). Associations
between characteristics of the nurse work environment and five nurse-sensitive patient
outcomes in hospitals: A systematic review of literature. International Journal of Nursing
Studies, 52(4), 817–835. Retrieved from
http://sciencedirect.com.library.capella.edu/science/article/pii/S0020748915000061?_rdo
c=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa
92ffb&ccp=y
Thomas, C. D. (2016). Transformational leadership as a means of improving patient care and
nursing retention (Doctoral dissertation). Retrieved from ProQuest. (Order No.
10125747).
Wong, C. A. (2015). Connecting nursing leadership and patient outcomes: State of the
science. Journal of Nursing Management, 23(3), 275–278. Retrieved from
http://onlinelibrary.wiley.com.library.capella.edu/doi/10.1111/jonm.12307/full
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 15
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
Appendix
Description of Quality and Safety Report 2015–2016
The Quality and Safety Report data for the year 2015–2016 represents four recognized
quality indicators in health care. The calculations are based on the total number of adverse events
and issues, differentiated by type, documented in TGH’s surgical units for 2015–2016. The
length of stay is calculated for patients who are admitted for more than 7 days. Patient
readmissions describe revisits by former surgical patients to the emergency department or
surgical units within 30 days of their discharge. The revisiting patients may sometimes require
additional hospital stay, which might be related to their surgical procedures.
The third indicator is based on medical pain where pain is rated on a scale of one to 10—
one being the mildest pain and 10 the most severe. TGH chose numbers between 7 and 10 on the
scale because a pain level between 7 and 10 that lasts for more than 24 hours is considered a
patient safety issue. The final indicator denotes pressure ulcers, which are injuries caused to skin
tissue resulting from prolonged pressure on the area. Patients bed-ridden after medical
procedures are at high-risk of pressure ulcers. The ideal benchmark for each indicator is zero,
which means that the goal of TGH is to prevent extended stays, readmissions, prolonged pain
without relief, and pressure ulcers in surgical patients.
2/25/22, 10:36 PMOriginality Report
Page 1 of 8https://courserooma.capella.edu/webapps/mdb-sa-BBLEARN/originality…5&course_id=_352412_1&includeDeleted=true&print=true&download=true
%%2
8
%%8
%%
1
SafeAssign Originality Report
NURS-FPX6016 – Winter 2022 – Section 03 • SafeAssign Draft Review
%%37To t a l S c o r eTo t a l S c o r e:: Medium risk
Stephanie Johnson
Submission UUID: 3a8cfc37-4ad7-9180-72ab-3051b625f3b
3
To t a l N u m b e r o f R eTo t a l N u m b e r o f R e……
1
H i g h e s t M a t c hH i g h e s t M a t c h
37 %
NURS-FPX6016_JohnsonSt…
A v e r a g e M a t c hA v e r a g e M a t c h
37 %
S u b m i t t e d o nS u b m i t t e d o n
02/25/
2
2
10:34 PM CST
A v e r a g e W o r d C o u n tA v e r a g e W o r d C o u n t
1,61
4
Highest: NURS-FPX6016_J…
%%37Attachment 1
I n s t i t u t i o n a l d a t a b a s eI n s t i t u t i o n a l d a t a b a s e ( (66))
S t u d e n t p a p e rS t u d e n t p a p e r S t u d e n t p a p e rS t u d e n t p a p e r
S t u d e n t p a p e rS t u d e n t p a p e r
S t u d e n t p a p e rS t u d e n t p a p e r S t u d e n t p a p e rS t u d e n t p a p e r S t u d e n t p a p e rS t u d e n t p a p e r
G l o b a l d a t a b a s eG l o b a l d a t a b a s e ( (44))
S t u d e n t p a p e rS t u d e n t p a p e r S t u d e n t p a p e rS t u d e n t p a p e r S t u d e n t p a p e rS t u d e n t p a p e r
S t u d e n t p a p e rS t u d e n t p a p e r
I n t e r n e tI n t e r n e t ( (11))
w i k i p e d i aw i k i p e d i a
To p s o u r c e sTo p s o u r c e s ( (33))
E x c l u d e d s o u r c e sE x c l u d e d s o u r c e s ( (00))
View Originality Report – Old Design
Word Count: 1,614
NURS-FPX6016_JohnsonStephanie_Assessment3_Attempt1 x
22 33
5
5
44
11
11
11
11
00
99
6
6
88
7
7
22 S t u d e n t p a p e rS t u d e n t p a p e r 33 S t u d e n t p a p e rS t u d e n t p a p e r 55 S t u d e n t p a p e rS t u d e n t p a p e r
1
2
Quality Improvement Initiative Proposal Stephanie Johnson 11
https://courserooma.capella.edu/webapps/mdb-sa-BBLEARN/originalityReport?attemptId=a86758e4-0a6b-4e9f-84e4-69a7f7f44025&course_id=_352412_1&download=true&includeDeleted=true&print=true&force=true
2/25/22, 10:36 PMOriginality Report
Page 2 of 8https://courserooma.capella.edu/webapps/mdb-sa-BBLEARN/originality…&course_id=_352412_1&includeDeleted=true&print=true&download=true
Capella University
February 25, 2022
Introduction
Hospitals all across the world have been working hard to improve patient care in recent years. As a result of better patient outcomes, hospitals’
reputations increase (Hakkak, 2019). Quality may be improved through supporting administration and medical staff, using evidence-based pro-
cedures, continual learning, collaboration among stakeholders, and good communication. Nurses’ involvement to quality improvement pro-
grams in healthcare organizations are critical, say Oikawa, et al (2021). Because they often interact with patients, they are vital in any effort to
improve care quality. Dashboard metrics from a healthcare company could be utilized to identify numerous difficulties. Quality improvement
seeks to strengthen the hospital’s weak points so that all patients receive excellent care. The Vila Health dashboard has 2014 and 2015 hospice
data. The data includes close misses and potential patient harm instances. The study covered quality factors like length of stay, inpatient unit,
pain, and symptom. Analysis of the Dashboard Metrics
Hospice patients necessitate a high level of care from healthcare professionals. The quality of the hospital’s care for hospice patients is di-
rectly related to this. A hospital’s ability to provide the best care to its most vulnerable patients can be gauged by looking at how well it does
this. Patient care is provided by a multidisciplinary team including nurses, dieticians, and other members of the medical team such as pharma-
cists and physicians, and therapists. All of them work together to ensure the patient’s safety and comfort. Table 1 shows that the length of
stay reduced from 50 days to 46 days and the number of IPUs decreased from 47 to 27 in hospice care. Though the hospital’s quality indicators
showed modest improvement, a rise in patients with severe pain and other symptoms is a bad sign for the hospital’s overall care. Effec-
tive, safe, dependable, patient-centered, equitable, and efficient care are the hallmarks of high-quality care (Oikawa, et al., 2021). Patients’ qual-
ity of life suffers in hospice because of ineffective pain treatment. The quality of care provided to patients in hospice care is directly influ-
enced by the assessment and management of pain. In terms of quality improvement, the decrease in length of stay isn’t big enough. The
longer a patient is in the hospital, the more likely they are to return. High readmission rates are linked to prolonged hospitalizations (Hakkak, et
al., 2019). As a result, hospitals should seek to reduce the length of stay for patients in order to improve patient care. Patients’ and the
hospital’s costs are considerable when patients are readmitted after an extended stay. Approximately 20% of Medicare patients are read-
mitted to the hospital within 30 days of discharge in the United States, resulting in an annual cost of $17 billion (Spatz, et al., 2020). The high
number of readmissions indicates a poor level of treatment at the hospital, which is something that most hospitals would like to avoid. The
data on duration of stay, severity of pain, and other symptoms suggests a problem with the quality of care, which might have serious ramifica-
tions for anyone involved in healthcare. The hospital’s ability to treat as many patients as it would like is curtailed when people lose faith in the
institution and its staff as a result of their actions. In addition to reducing hospital revenue, fewer patients mean lesser reimbursement from
insurance companies, which in turn can lower employee morale, which in turn has a negative impact on care quality. It’s clear that quality
needs to be improved based on the length of stay, symptoms, and degree of pain. Quality Initiative Proposal
Nursing leadership is critical to enhancing patient care in all healthcare environments. The ability of healthcare organizations to provide better
care depends on its executives’ ability to lead effectively (Wilkes, 2019). As a result, a change in the healthcare facility’s top management will
help improve patient care. Hospitals are encouraged to reduce the length of stay for patients and enhance other quality metrics, such as
pain level and symptoms for hospice care patients, because of the negative consequences of readmissions, which grow with the length of stay.
Medicare and Medicaid Services (CMS) started the Hospital Readmission Reduction Program in 2012 to reduce readmissions (HRRP). For
hospitals with high rates of re-admission within 30 days of discharge, the HRRP permits Medicare and Medicaid to reduce payments (Permaru-
pan, 2020). Consequently, each hospital must try to improve the quality of treatment it provides to its patients. Efforts to increase quality are
not working. The nursing team is not sufficiently motivated by the leader’s leadership style to help improve the hospice patients’ care. The
ability of a healthcare facility’s leadership to inspire and encourage its employees is critical to the facility’s success (Cheon, 2021).
22
33
22
22
33
44
44
33
33
55
66
33
After a year, there has been no notable change in the leadership’s performance. Rather than encouraging the nurses to improve themselves by
motivating them and providing a supportive environment, this demonstrates a lack of commitment and dedication on the part of the supervi-
sor. The Model for Improvement can help improve hospice care. Using this method, you can divide improvement tasks into two halves. The
first segment asks three questions: what is to be achieved, how an improvement is determined, and what adjustments are performed as a re-
sult. The hospital wants to improve treatment for hospice patients. The number of patients who have gone through the various quality mea-
surement processes will inform if there have been any improvements. For example, a significant drop in the number of patients who are
hospitalized or in severe pain will indicate a significant improvement. To increase quality, transformative leadership is required. The Model
for Improvement’s Plan-Do-Study-Act (PDSA) cycle will also help implement improvements at the hospital. The PDSA cycle comprises four
stages: plan, execute, study, and act. Plan
This is the first step in the process, which includes making preparations for the test. For the hospital to prepare for this shift, data collec-
tion mechanisms can be identified during the test to determine whether any modifications are being made there. For the initial test, they
22
33
55
44
2/25/22, 10:36 PMOriginality Report
Page 3 of 8https://courserooma.capella.edu/webapps/mdb-sa-BBLEARN/originality…&course_id=_352412_1&includeDeleted=true&print=true&download=true
S o u r c e M a t c h e sS o u r c e M a t c h e s ( (3 53 5))
Student paper 68%
can also plan which component of hospice care to use. Do
It entails doing a small-scale test. The hospital can test the impact of the new leadership style on a subset of hospice patients or a
small area of hospice service (Cheon, 2021). Study
A comparison of the data acquired before and after the study is necessary. It helps to determine whether or not the change is worth executing
in the first place. Act
Based on the comparisons and analysis of data, the change is refined at this step. Agency of Healthcare Research and Quality recognized
quality indicators include mortality, usage rate, and volume. As a result, fluctuations in the number of patients might provide insight into a hos-
pital’s overall quality of care. Because only four quality indicators are utilized in the experiment, the inter-professional team can overcome
the obstacle of not fully comprehending the situation. Integrate Inter-professional Perspectives to Lead Quality Improvements
It is possible to improve patient care by incorporating the opinions of different professions. The experts have a wide range of talents, and they
may work together to improve healthcare organizations’ quality of care. It is the ability of each healthcare professional to accept their
complementary roles in a team, share problem-solving duties, work together, and make decisions that contribute to efficient patient care that
constitutes inter-professional collaboration (Moriyama, 2019). Effective Communication Strategies to Promote Quality Improvement
The inter-professional team’s ability to communicate effectively is critical to its success. Inter-professional teams can benefit from using
the Strategies and Tools to Improve Performance and Patient Safety to improve communication. The strategy’s tools provide a scientific frame-
work for improving team communication. Effective teamwork is possible because of the strategy’s removal of subjective and emotional charge
(Moriyama, 2019). Conclusion
To guarantee that patients receive the best possible treatment, healthcare facilities must continually enhance their quality. Reduce the
number of patients experiencing excessive pain and shorten their hospital stay by collaborating with other healthcare professionals to improve
quality of treatment and minimize readmission rates. All stakeholders will benefit if the quality of care is improved. The inter-professional
team’s interaction and efficiency can be improved by the use of tactics like the SBAR communication model, which is based on the PDSA cycle.
References
Cheon, O., Song, M., Mccrea, A. M., & Meier, K. J. (2021). Health care in America: The relationship between subjective and objective assess-
ments of hospitals. International Public Management Journal, 24(5), 596-622. Hakkak, M., Hozni, A., Vahdati, H., & Nazarpouri, A. (2019). Nurs-
ing leadership competency learning-an integrative review. Future of Medical Education Journal, 9(4), 46-54. Moriyama, H., Kohno, T., Kohsa-
ka, S., Shiraishi, Y., Fukuoka, R., Nagatomo, Y.,… & Yoshikawa, T. (2019). Length of hospital stay and its impact on subsequent early readmis-
sion in patients with acute heart failure: a report from the WET-HF Registry. Heart and vessels, 34(11), 1777-1788. Oikawa, S., & Donkers, J.
(2021). Assessment of teamwork in interprofessional education. Journal of Interprofessional Care, 1-8. Permarupan, P. Y., Al Mamun,
A., Samy, N. K., Saufi, R. A., & Hayat, N. (2020). Predicting nurses burnout through quality of work life and psychological empower-
ment: A study towards sustainable healthcare services in Malaysia.
Sustainability, 12(1), 388
. Spatz, E. S., Bernheim, S. M., Horwitz, L. I., &
Herrin, J.
22 55
22
22
33
77
33
22
44
77
88
9
9
88
99 1 01 0
1 11 1 1 01 0
1 11 1
(2020). Community factors and hospital wide readmission rates: Does context matter?. PloS one, 15(10), e0240222. Wilkes, M. S., Conrad, P. A.,
& Winer, J. N. (2019). One health–one education: medical and veterinary inter-professional training. Journal of veterinary medical education,
46(1), 14-20.
1
Student paper
Quality Improvement Initiative Proposal Stephanie Johnson
Original source
Long Term Quality Improvement Initiative Proposal
2/25/22, 10:36 PMOriginality Report
Page 4 of 8https://courserooma.capella.edu/webapps/mdb-sa-BBLEARN/originality…&course_id=_352412_1&includeDeleted=true&print=true&download=true
Student paper 68%
Student paper 67%
Student paper 66%
Student paper 66%
Student paper 78%
Student paper 70%
Student paper 71%
2
Student paper
February 25, 2022
Original source
January 25, 2022
3
Student paper
Analysis of the Dashboard Metrics
Original source
Analysis of Dashboard Metrics to Identify Quality Issues
2
Student paper
The quality of the hospital’s care for hospice patients is directly related to
this.
Original source
The hospital’s goal is to improve the quality of care provided to hospice
patients
2
Student paper
Table 1 shows that the length of stay reduced from 50 days to 46 days and
the number of IPUs decreased from 47 to 27 in hospice care.
Original source
According to hospice care data, the average length of stay fell from 50 to 45
days, and the average number of IPUs decreased from 47 to 25
3
Student paper
Effective, safe, dependable, patient-centered, equitable, and efficient care are
the hallmarks of high-quality care (Oikawa, et al., 2021).
Original source
Effective, safe, dependable, patient-centered, equitable, and efficient care are
all characteristics of high-quality care
4
Student paper
The quality of care provided to patients in hospice care is directly influenced
by the assessment and management of pain.
Original source
Pain assessment and treatment have a major impact on the quality of care
provided to patients in hospice care
4
Student paper
As a result, hospitals should seek to reduce the length of stay for patients in
order to improve patient care.
Original source
As a result, hospitals should try to reduce patient lengths of stay to improve
care quality
2/25/22, 10:36 PMOriginality Report
Page 5 of 8https://courserooma.capella.edu/webapps/mdb-sa-BBLEARN/originality…&course_id=_352412_1&includeDeleted=true&print=true&download=true
Student paper 62%
Student paper 100%
Student paper 70%
Student paper 84%
Student paper 63%
Student paper 65%
Student paper 77%
3
Student paper
Approximately 20% of Medicare patients are readmitted to the hospital with-
in 30 days of discharge in the United States, resulting in an annual cost of $17
billion (Spatz, et al., 2020).
Original source
United States of America experience approximately 20% Medicare patients’
readmission 30 days post discharge, resulting in a $17 billion yearly expense
(Sud et al., 2017)
3
Student paper
Quality Initiative Proposal
Original source
Quality Initiative Proposal
5
Student paper
Hospitals are encouraged to reduce the length of stay for patients and en-
hance other quality metrics, such as pain level and symptoms for hospice
care patients, because of the negative consequences of readmissions, which
grow with the length of stay.
Original source
The consequences for hospitals in the event of readmission, which increase
in direct proportion to the duration of stay, drive hospitals to reduce patient
length of stay and enhance other quality metrics such as level of pain and
symptomatology for hospice care patients
6
Student paper
Medicare and Medicaid Services (CMS) started the Hospital Readmission Re-
duction Program in 2012 to reduce readmissions (HRRP).
Original source
In 2012, the Centers for Medicare & Medicaid Services (CMS) started the Hos-
pital Readmissions Reduction Program (HRRP) to reduce hospital
readmissions
3
Student paper
The nursing team is not sufficiently motivated by the leader’s leadership style
to help improve the hospice patients’
Original source
The nursing staff is not sufficiently motivated by the leadership style to im-
prove the quality of services provided
2
Student paper
For example, a significant drop in the number of patients who are hospital-
ized or in severe pain will indicate a significant improvement.
Original source
For example, a significant drop in the number of patients admitted to the
hospital for a lengthy amount of time or who have severe pain shows an
improvement
3
Student paper
The Model for Improvement’s Plan-Do-Study-Act (PDSA) cycle will also help
implement improvements at the hospital. The PDSA cycle comprises four
stages:
Original source
The Plan-Do-Study-Act (PDSA) cycle in the Improvement Model will also aid in
the implementation of the improvements at the hospital The PDSA cycle has
four stages
2/25/22, 10:36 PMOriginality Report
Page 6 of 8https://courserooma.capella.edu/webapps/mdb-sa-BBLEARN/originality…&course_id=_352412_1&includeDeleted=true&print=true&download=true
Student paper 69%
Student paper 68%
Student paper 77%
Student paper 68%
Student paper 73%
Student paper 64%
Student paper 76%
5
Student paper
For the hospital to prepare for this shift, data collection mechanisms can be
identified during the test to determine whether any modifications are being
made there.
Original source
The hospital can prepare for this change by establishing methods for data
collection during the test to determine whether or not changes are being
made
4
Student paper
For the initial test, they can also plan which component of hospice care to
use.
Original source
Additionally, they can plan which section of hospice care will be used for the
initial test
2
Student paper
It entails doing a small-scale test.
Original source
It entails doing the test on a modest scale
5
Student paper
The hospital can test the impact of the new leadership style on a subset of
hospice patients or a small area of hospice service (Cheon, 2021).
Original source
The hospital can test the impact of the change in leadership style on a subset
of hospice patients or a random sample of patients
2
Student paper
Based on the comparisons and analysis of data, the change is refined at this
step. Agency of Healthcare Research and Quality recognized quality indica-
tors include mortality, usage rate, and volume.
Original source
At this step, the modification is refined based on what was discovered
through data comparisons and analysis The Agency for Healthcare Research
and Quality has established quality indicators for mortality, utilization, and
volume
2
Student paper
Because only four quality indicators are utilized in the experiment, the inter-
professional team can overcome the obstacle of not fully comprehending the
situation.
Original source
Because just four quality indicators are employed in the experiment, the in-
terprofessional team may face the obstacle of not fully comprehending the
breadth of the problem
3
Student paper
Integrate Inter-professional Perspectives to Lead Quality Improvements
Original source
Integrate Interprofessional Perspectives to Lead Quality Improvements
2/25/22, 10:36 PMOriginality Report
Page 7 of 8https://courserooma.capella.edu/webapps/mdb-sa-BBLEARN/originality…&course_id=_352412_1&includeDeleted=true&print=true&download=true
wikipedia 100%
Student paper 100%
Student paper 67%
Student paper 62%
wikipedia 81%
Student paper 100%
Student paper 100%
7
Student paper
quality of care.
Original source
“The quality of care
3
Student paper
Effective Communication Strategies to Promote Quality Improvement
Original source
Effective Communication Strategies to Promote Quality Improvement
2
Student paper
Inter-professional teams can benefit from using the Strategies and Tools to
Improve Performance and Patient Safety to improve communication. The
strategy’s tools provide a scientific framework for improving team
communication.
Original source
The Strategies and Tools to Improve Performance and Patient Safety (STEPPS)
can improve communication among interprofessional team members The
strategy’s tools provide an evidence-based foundation for improving team
communication
4
Student paper
Reduce the number of patients experiencing excessive pain and shorten their
hospital stay by collaborating with other healthcare professionals to improve
quality of treatment and minimize readmission rates.
Original source
An interdisciplinary team can collaborate to improve care quality, reduce the
number of patients experiencing excessive pain, and also shorten hospital
stays, resulting in lower readmission rates
7
Student paper
Health care in America:
Original source
Delivering Health Care in America
8
Student paper
Moriyama, H., Kohno, T., Kohsaka, S., Shiraishi, Y., Fukuoka, R., Nagatomo,
Y.,…
Original source
Moriyama, H., Kohno, T., Kohsaka, S., Shiraishi, Y., Fukuoka, R., Nagatomo, Y.,
9
Student paper
Length of hospital stay and its impact on subsequent early readmission in
patients with acute heart failure: a report from the WET-HF Registry.
Original source
Length of hospital stay and its impact on subsequent early readmission in
patients with acute heart failure a report from the WET-HF Registry
2/25/22, 10:36 PMOriginality Report
Page 8 of 8https://courserooma.capella.edu/webapps/mdb-sa-BBLEARN/originality…&course_id=_352412_1&includeDeleted=true&print=true&download=true
Student paper 100%
Student paper 64%
Student paper 100%
Student paper 100%
Student paper 100%
Student paper 100%
8
Student paper
Heart and vessels, 34(11), 1777-1788.
Original source
Heart and vessels, 34(11), 1777-1788
9
Student paper
Journal of Interprofessional Care, 1-8.
Original source
Journal of Interprofessional Care, 33(1), 85–92
10
Student paper
Y., Al Mamun, A., Samy, N. K., Saufi, R.
Original source
Y., Al Mamun, A., Samy, N K., Saufi, R
11
Student paper
A., & Hayat, N.
Original source
A., & Hayat, N
10
Student paper
Predicting nurses burnout through quality of work life and psychological em-
powerment: A study towards sustainable healthcare services in Malaysia.
Original source
Predicting Nurses Burnout through Quality of Work Life and Psychological
Empowerment A Study towards Sustainable Healthcare Services in Malaysia
11
Student paper
Sustainability, 12(1), 388.
Original source
Sustainability, 12(1), 388
