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Quality Improvement Initiative Proposal

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Quality Improvement Initiative Proposal

In this assessment, you will propose a quality improvement (QI) initiative proposal based on a health issue of professional interest to you. The QI initiative proposal will be based on an analysis of dashboard metrics from a health care facility. You have one of two options:

Option 1

If you have access to dashboard metrics related to a QI initiative proposal of interest to you:

  • Analyze data from the health care facility to identify a health care issue or area of concern. You will need access to reports and data related to care quality and patient safety. If you work in hospital setting, contact the quality management department to obtain the data you need.
  • You will need to identify basic information about the health care setting, size, and specific type of care delivery related to the topic that you identify. You are expected to abide by HIPAA compliance standards.
Option 2

If you do not have access to a dashboard or metrics related to a QI initiative proposal:

  • You may use the hospital data set provided in the media piece titled Vila Health: Data Analysis. You will analyze the data to identify a health care issue or area of concern.
  • You will follow the same instructions and provide the same deliverables as your peers who select Option 1.

Instructions

Analyze dashboard metrics related to the selected issue.

  • Provide the selected data set in the proposal.
    • Assess the stability of processes or outcomes.
    • Delineate any problematic variations or performance failures.
  • Evaluate QI initiatives on the selected health issue with existing quality indicators from other facilities, government agencies, and non-governmental bodies on quality improvement.
    • Analyze challenges that meeting prescribed benchmarks can pose for a heath care organization and the interprofessional team.
  • Outline a QI initiative proposal based on the selected health issue and data analysis.
    • Identify target areas for improvement.
    • Define what processes can be modified to improve outcomes.
    • Propose strategies to improve quality.
    • Define interprofessional roles and responsibilities as they relate to the QI initiative.
    • Provide recommendations for effective communication strategies for the interprofessional team to ensure the success of the QI initiative. Briefly reflect on the impact of the proposed initiative on work-life quality of the nursing staff and interprofessional team.
  • Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.

Note: Remember, you can submit all, or a portion of, your draft to Smarthinking for feedback, before you submit the final version of your analysis for this assessment. However, be mindful of the turnaround time for receiving feedback, if you plan on using this free service.

Quality Improvement Initiative Proposal

The numbered points below correspond to grading criteria in the scoring guide. The bullets below each grading criterion further delineate tasks to fulfill the assessment requirements. Be sure that your Quality Improvement Initiative Evaluation addresses all of the content below. You may also want to read the scoring guide to better understand the performance levels that relate to each grading criterion.

  1. Analyze data to identify a health care issue or area of concern.
    • Identify the type of data you are analyzing (from your institution or from the media piece).
    • Discuss why the data matters, what it is telling you, and what is missing.
    • Analyze dashboard metrics and provide the data set in the proposal.
    • Present dashboard metrics related to the selected issue.
    • Delineate any problematic variations or performance failures.
    • Assess the stability of processes or outcomes.
    • Evaluate the quality of the data and what can be learned from it.
    • Identify trends, outcome measures and information needed to calculate specific rates.
    • Analyze what metrics indicate opportunities for quality improvement.
  2. Outline a QI initiative proposal based on a selected health issue and supporting data analysis.
    • Identify benchmarks aligned to existing QI initiatives set by local, state, or federal health care policies or laws.
    • Identify existing QI initiatives related to the selected issue, and explain why they are insufficient.
    • Identify target areas for improvement, and define what processes can be modified to improve outcomes.
    • Propose evidence-based strategies to improve quality.
    • Evaluate QI initiatives on the selected health issue with existing quality indicators from other facilities, government agencies, and non-governmental bodies on quality improvement.
    • Analyze challenges that meeting prescribed benchmarks can pose for a heath care organization and the interprofessional team.
  3. Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work-life quality.
    • Define interprofessional roles and responsibilities as they relate to the data and the QI initiative.
    • Explain how you would you make sure that all relevant roles are fully engaged in this effort.
    • Explain what non-nursing concepts would you incorporate into the initiative?
    • Identify how outcomes to measure the effect of the intervention affect the interprofessional team.
    • Briefly reflect on the impact of the proposed initiative on work-life quality of the nursing staff and interprofessional team. Describe how work-life quality is improved or enriched by the initiative.
  4. Apply effective communication strategies to promote quality improvement of interprofessional care.
    • Identify the kind of interprofessional communication strategies that will be effective to promote and ensure the success of this performance improvement plan or quality improvement initiative.
    • In addition to writing, identify communication models (like CUS, SBAR) that you would include in your initiative proposal.
  5. Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
  6. Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.

Quality Improvement Initiative Proposal

Submission Requirements

  • Length of submission: 8–10 double-spaced, typed pages, not including title and reference page.
  • Number of references: Cite a minimum of five sources (no older than seven years, unless seminal work) of scholarly, peer-reviewed, or professional evidence that support your evaluation, recommendations, and plans.

 

QUESTIONS TO CONSIDER:

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

Reflect on QI initiatives focused on measuring and improving patient outcomes with which you are familiar.

  • How important is the role of nurses in QI initiatives?
  • What quality improvement initiatives have made the biggest difference? Why?
  • When a QI initiative does not succeed as planned, what steps are taken to improve or revise the effort?

 

SAMPLE ANSWER

Quality Improvement Initiative Proposal

Introduction

The increasing concern about patient safety and reducing adverse events in healthcare have led to more focus being directed towards initiatives that improve quality. In the past, QI initiatives have failed to get support from all healthcare professionals and as a result, have faltered to create permanent change. Many healthcare professionals report resistance when QI initiatives are introduced. To reduce resistance and ensure success, QI initiatives must engage all healthcare providers in all the developmental stages (White, Butterworth & Wells, 2017). Medical errors are at the center of factors that affect quality of care and threaten patient safety. However, with the increasing prominence of electronic health records, many healthcare facilities are using new tools to reduce risks of errors. The proposal will provide a quality improvement initiative to reduce preventable medical errors and infection rates in the ICU department at Virginia Commonwealth University Health System (VCUHS). Data will be obtained from the facility’s clinical dashboard metrics.

About the facility

VCUHS is a Level one trauma center located in Richmond, Virginia. The facility provides care to a population of over 1.2 million individuals since it is the only level one trauma center in the Central Virginia region. With a vision of improving quality, safety and effectiveness of care, the facility has invested in technological systems and tools that facilitate the transformation of clinical practice (VCUHealth, 2019). The Critical Care Hospital at VCU Medical Center is equipped with the latest technology including advanced monitoring devices and mechanical ventilators. Some of the intensive care units at the Critical Care Hospital include; the neuroscience ICU, cardiac surgery ICU, coronary ICU, surgery trauma ICU and the Medical respiratory ICU (VCUHealth, 2019). However, between the years of 2006 and 2008, there were nearly one million patient safety lapses among Medicare patients. As a result, over 100,000 deaths were recorded and excess costs amounting to 8.9 billion USD were incurred. With these numbers in the mind, the facility’s management announced a new safety vision to help the facility become the safest one in America. To achieve its mission, QI initiatives must be implemented to reduce preventable medical errors that result in death.

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Analysis of Dashboard Metrics to Identify Quality Issue

Healthcare-associated infections (HCAIs) are infections that are acquired by patients who are receiving treatment in hospitals or healthcare facilities. Additionally, HCAIs appear within 48 hours of hospitalization or within 30 days after receiving care (Haque, Sartelli, McKimm & Bakar, 2018). According to statistics from the U.S Center for Disease Control and Prevention, approximately 1.7 million patients annually acquire HCAIs during treatment and 98,000 of these patients die due to the infections. To reduce the death rate associated with HCAIs, simple infection-control procedures liked hand cleaning with an alcohol-based hand rub have been proven to be effective. Additionally, routine educational interventions for all staff members will help improve hand hygiene practices in healthcare facilities and prevent the spread of infections (Haque et al., 2018). Patients in the ICU are more prone to contracting HCAIs due to reduced host defense mechanisms, non-conformance with infection prevention and control measures, heavy workload on staff and lack of training resulting in cross-contamination and cross-transmission of germs from one patient to the next (Damani, 2015).

According to recent rankings by the Leapfrog Group, a non-profit hospital watchdog institution, Virginia received the second-highest rate of hospital with A ratings for patient safety. However, last on the list with the lowest patient safety rating was VCU Health System which received grade C (Balch, 2019). The ratings by Leapfrog Group are based on public data on the hospitals’ rates of infections, deaths from surgery, patient falls, injuries and other preventable injuries. The C rate that VCU received places the facility at 88 percent greater risk of patients’ death (Balch, 2019).

Table 1: Leapfrog Hospital Safety Grade for VCU Health System

Infection MRSA Clostridium

difficile

 Blood infections Urinary tract infections Surgical site infection after colon surgery
VCU Score 0.931 1.354 0.902 0.569 0.809
Best hospital’s score 0.000 0.000 0.000 0.000 0.000
Average hospital’s score 0.881 0.751 0.765 0.831 0.860
Worst hospital’s score 3.352 1.940 2.943 3.010 3.067

 

The table above containing scores of VCU’s infection rate was compiled by Leapfrog Hospital safety grade and contributed to its eventual grade of C. The number represents a comparison of the number of infections expected for VCU, given the number of patients they care for on a daily basis and how widespread every infection is in the local community. A number lower than one means that the facility had fewer infections than expected; a number higher than one means that the facility had more infections than expected (Leapfrog Hospital Safety Grade, 2019). Leapfrog Hospital Safety Grade obtained data from hospital survey and CMC. The data that was used to come up with the overall C grade was divided into five categories; infections, problems with surgery, practices to prevent errors, safety problems, doctors, nurses and hospital staff. Overall, VCUHS is facing high HCAIs compared to other medical facilities in the country and compared to acceptable standards.

The center for Adult Critical Care at VCUHS offers 24/7 intensive care services to the critically ill and injured. With over 30 board-certified and fellowship-trained critical care specialists, the Critical Care Hospital serves a majority of residents in Virginia. According to VCUHS 2013 annual report that obtained data from the facility’s clinical dashboard, there was an 86% reduction in healthcare-associated infections in the ICU since 2003 (VCU Medical Center, 2018). However, the rate of HCAIs is still high and the facility is in argent need of a QI initiative to reduce this quality issue.

Table 2: Infections in the ICU

Year 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Infections

Per 1,000

Patient days

 22.5 17.5 12.5 10.0 7.2 6.0 2.5 2.5 2.4 2.0 2.2

 

Table 2 above highlights the rate of infections in the ICU between 2003 and 2013. According to the table, the facility had an infection rate of 22.5 per 1000 patient days in the year 2003. Over the following years, the number drastically reduced and by 2013, the number reached 2.2 infections per 1000 patient days.

There are four main categories of healthcare associate infection s identified in the data. They include; catheter-associate urinary tract infections (CAUTI), surgical site infections (SSI), ventilator-associated pneumonia (VAP) and central line associated bloodstream infection (CLABSI).

 

Table 3: Rate of Healthcare Associated Infections in the ICU

Table 3 above highlights the rate of healthcare associated infections at VCUs ICU hospital. At 39% CAUTIs are most common HAIs in the facility. This is followed by SSI at 26%, VAP at 18% and CLABSI at 17%.

Table 4: Graph of infection rates per 1000 patient days

The graph above provides a visual presentation of the rate of infections per 1000 patient days. In 2003, VCU had the highest rate of infections in its ICU. However, between 2009 and 2013, the numbers stagnated. This is partly attributed to improved hand hygiene practices among healthcare providers in the facility.

Quality Improvement Initiative Proposal

In line with its mission of being the safest healthcare facility in America, the number of preventable errors must be significantly reduced. In addition to saving lives and improving quality of care for patients, an effective quality improvement initiative will save the facility billions of dollars in damage control after an infection has occurred. The quality improvement initiative for VCU will be based on the rate of Healthcare-associated infections and will use data from the facility’s dashboard regarding the healthcare issue. The QI outline will also identify knowledge gaps, missing information and areas of uncertainty and provide effective solutions to reduce HAIs at VCU.

Outline for the Quality Improvement Initiative

Healthcare-associated infections (HAIs) are increasingly becoming a major patient safety problem in healthcare facilities. With over 1.7 million HAIs and approximately 99,000 healthcare-associated deaths in hospitals, HAIs are a major concern for all stakeholders involved (Mauger et al., 2014). However, considerable progress has been made in identifying preventive strategies and interventions to reduce HAIs. Some of the most preferred strategies include; the use of audits, feedback and provider reminder systems that are in line with the base strategies of organizational change and provider education (Mauger et al., 2014). Considering morbidity and mortality rates, cost implications and the length of stay in the hospital, efforts should be directed towards developing HAI prevention strategies.

Quality Improvement Initiative Proposal

There are several general measures that can be implemented to control infection rates in the ICU. One of the measures is isolation. The need for isolation should be assessed by screening all ICU patients for immunological disorders, diarrhea, skin rashes, communicable diseases or presence of symptoms of an epidemic bacterium (Mehta et al., 2014). After the need for isolation is assessed, the type of isolation needed should be selected. Isolation can either be protective isolation for immunocompromised patients or source isolation for infected patients to control infection transmission to other patients and staff members. Healthcare professionals should also identify patients who are at a higher risk of nosocomial infections. In addition to isolation, healthcare professionals should always observe hand hygiene. Hands are the primary vehicle for the transmission of microorganisms and observing hand hygiene is the most effective way of preventing horizontal transmission of infections within the ICU (Mehta et al., 2014). In line with this realization, VCU should strictly adhere to WHO’s five moments for hand hygiene.

Figure 1: World Health Organization’s Five Moments for Hand Hygiene

 

Quality Improvement Initiative Proposal

In addition to strictly following the WHO five moments for hand hygiene, healthcare providers should wash their hands with soap and running water after they are visibly soiled with blood or other body fluids. They should also use an alcohol-based hand rub containing 0.5% chlorhexidine and 70% w/v ethanol when their hands are not visibly dirty (Mehta et al. 2014). Regardless of the patient’s status, healthcare professionals should always adhere to standard precautions every time they are in contact with patients in the ICU. Some of the Personal Protective Equipment (PPE) to consider includes sterile gloves, gowns, masks, eye protection equipment, face shields, shoe and head coverings and patient-care equipment. Transmission-based precautions should also be adhered to in addition to standard precautions.

Strategies to reduce ventilator-associated pneumonia (VAP)

  • Intubation should be avoided whenever necessary
  • Use noninvasive ventilation
  • Use oral intubations to nasal intubations
  • Patient’s head should be elevated at a 30-45-degree angle in a semi-recumbent body position
  • Chlorhexidine solution of 0.12% strength should be given orally everyday
  • Use endotracheal tubes with subglottic suction port
  • Periodic discharge of any condensate in the mechanical ventilator tubing should be regularly checked (Mehta et al. 2014)

Quality Improvement Initiative Proposal

Strategies to reduce Catheter-related bloodstream infection (CRBSI)

  • Catheter insertion should be done in the upper extremity
  • Before inserting the catheter, skin should be cleaned with more than 0.5% chlorhexidine preparation
  • Ultrasound-guided insertion should be used
  • Catheter insertion site should be monitored on a daily basis to check if a transparent dressing is present
  • Needless intravascular catheter access systems should be used
  • Injection ports should be cleaned with appropriate antiseptics (Mehta et al. 2014)

Strategies to reduce urinary tract infection (UTI)

  • Catheters should only be inserted for appropriate indications
  • Urinary catheter should be aseptically inserted
  • A closed drainage system should be maintained
  • Maintain unobstructed urine flow
  • Catheters that are no longer needed should be removed (Mehta et al. 2014)

Lastly, environmental factors like cleaning and disinfection should be maintained at all times. Patient-care areas should be cleaned and disinfected regularly. Some pathogens like methicillin-resistant Staphylococcus aureus (MRSA) can survive in the environment for longer periods of time. Therefore, EPA-registered disinfectants that are best suited to meet all the needs of the ICU should be used for cleaning and disinfection. The architecture and layout of the ICU should also be considered. The ICU should be situated close to the operating room and emergency department to allow for easy access at all times. Additionally, all air in the ICU should be filtered to approximately 99% efficiency (Mehta et al. 2014). The isolation facility should always have both negative and positive pressure ventilations. Space between beds should be kept and a minimum of 2.5 meters.

All the proposed quality improvement measures to reduce HAIs will not be successful unless the organization’s management offers its support. Therefore, the QI implementation team should work closely with the hospital’s management and lobby for a better patient to nurse ratio in the ICU. Likewise, policies for controlling traffic flow in the ICU should be implemented to reduce possible sources of contamination from staff members, equipment and visitors (Mehta et al 2014). Education and training should be offered to all ICU staff to help improve their knowledge on nosocomial infections. Antibiotic stewardship and vaccination of ICU healthcare personnel should be adhered to.

The aforementioned quality improvement strategies will only be effective if an interprofessional approach is taken. Therefore, the next stage of the proposal will integrate interprofessional perspectives to lead quality improvement in patients.

Interprofessional Perspectives to Support Quality Improvement

Patients have complex health needs and often require several disciplines to address their health issues. According to recommendations by the Institute of Medicine Committee on Quality of Health Care in America, all healthcare professionals should work in interprofessional teams to best address the complex needs of patients (Bridges et al. 2014). By working in teams, healthcare professionals are able to share expertise and unique perspectives to form a common goal of restoring health and improving patient outcomes. The success of interprofessional teams is based on several assumptions including; interprofessional team members see their roles as important to the team, all healthcare professionals’ value patient safety and work towards observing quality standards, there is open communication among team members, there is existence of autonomy and equality in resource sharing (Bridges et al. 2014).

Based on the assumption that interprofessional team members see their roles as important, the organization’s leadership should be at the forefront in infection control and prevention. Leadership plays an important role in the implementation of guideline recommendations and organizing for training and education activities (Hegarty et al. 2018). By demonstrating tangible support to teams, ensuring that resources are available to facilitate change and hiring healthcare practitioners, leadership facilitates quality improvement in the organization. In their role as facilitators, organization’s leaders guide the implementation of standards, strategic approaches and the principles of bottom-up working. In line with this, VCU leadership has a crucial role to play to reduce the rate of healthcare-associated infections in the facility. By contributing to infection prevention actions and by implementing guidelines, the hospital’s leadership facilitates the QI process. Leadership should also listen to workforce concerns, motivate and engage healthcare workers, acknowledge when staff members are stressed and overstretched, overcome challenges that HAIs prevention strategies face and promote collaboration across all disciplines (Hegarty et al., 2018).

Quality Improvement Initiative Proposal

Effective Communication Strategies to Promote Quality Improvement

Effective communication is crucial to the success of all quality improvement initiatives. In line with this assumption, VCU should design a communication strategy that engages every staff member in the ICU, promotes awareness and understanding of all the QI interventions proposed to reduce the rate of HCAIs in the ICU hospital (Cooper et al., 2015). Overall, systematic and structured communication strategies enhance quality improvement initiatives.

In line with the assumption that all healthcare providers value patient safety and strive to observe quality standards, healthcare workers as members of interprofessional teams have a crucial role to play in the reduction of HCAIs (Shah & Holmes, 2015). Understanding healthcare worker’s behavior is critical to develop effective behavior change interventions. Studies show that HCAIs are mainly caused by healthcare workers who are not compliant with IPC practices. This behavior is often attributed to a lack of effective communication, environmental circumstances, duties and social circumstances. To reduce non-compliance rates among ICU staff members, VNU should analyze the hierarchy of influence in traditional clinical roles that challenge work relationships. Additionally, the facility should prioritize risk appraisals to remove any and all divergence in values attached to its policies and practices (Shah & Holmes, 2015). Lastly, the facility should remove ambiguities surrounding healthcare workers’ duties and responsibilities.

Quality Improvement Initiative Proposal

Conclusion

For healthcare organizations like VCU Medical Center, maintaining quality is of the upmost importance. Thus, when there are quality-related issues like increased rates of HCAIs in the ICU department, the facility should immediately implement a quality improvement initiative that will address the safety issue and improve overall performance of the facility. Effective quality improvement initiatives should have interprofessional perspectives imbedded in them and effective communication strategies that ensure that communicate the QI goals and objectives to all the stakeholders involved. While QI initiatives are designed to control quality-related issues, they have little chance of success if the organization’s management does not support them.

 

 

References

Balch, B. (2019). Hospital Safety Report: Virginia Ranks Second Best in Nation: VCU, Southside Regional Lag with C Grade. Richmond Times-Dispatch. Retrieved from https://www.google.com/amp/s/www.richmond.com/hospital-safety-report-virginia-ranks-second-best-in-nation-vcu/article.amp.html

Bridges, D.R., Davidson, R.A., Odegard, P.S., Maki, I.V & Tomkowiak, J. (2014). Interprofessional Collaboration: Three Best Practice Models of Interprofessional Education. Medical Education Online, 16. Doi: 10.3402/meo.v16i0.6035

Cooper, A., Gray, J., Willson, A. et al (2015). Exploring the Role of Communications in Quality Improvement: A Case Study of the 1000 Lives Campaign in NHS Wales. Journal of Communication in Healthcare, 8(1), 76-84. Doi: 10.1179/1753807615Y.000000000000006

Damani, N. (2015). Healthcare-associated Infections in Intensive Care Units: Epidemiology and Infection Control in Low-to-middle Income Countries. J Infect Dev Ctries, 9(10), 1040-1045. Doi: 10.3855/jidc.6832

Haque, M., Sartelli, M., McKimm, J. & Bakar, M. (2018). Health Care-Associated Infections- an Overview. Infection and Drug Resistance, 11, 2321-2333. Doi: 10.2147/IDR.S177247

Hegarty, J., Murphy, S. et al. (2018). Leadership Perspectives on the Implementation of Guidelines on Healthcare-associated Infections. BMJ Leader, 3(2). Doi: 10.1136/leader-2018-000111

Mauger, B., Marbella, A., Pines, E., Chopra, R., Black, E.R & Aronson, N. (2014). Implementing Quality Improvement Strategies to Reduce Healthcare-associated Infections: A Systematic Review. American Journal of Infection Control, 42, S274-S283. Doi: 10.1016/j.ajic.2014.05.031

Mehta, Y., Gupta, A., Todi, S., Myatra, S.N. et al. (2014). Guidelines for Prevention of Hospital Acquired Infections. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine, 18(3), 149-163. Doi: 10.4103/0972-5229.128705

Shah, N. & Holmes, A.H. (2015). Towards Changing Healthcare Workers’ Behavior: a Qualitative Study Exploring non-Compliance through Appraisals of Infection Prevention and Control Practices. Journal of Hospital infection, 90(2), 126-134. Doi: 10.1016/j.jhin.2015.01.023

VCUHealth. (2019). Our Story. Retrieved from https://www.vcuhealth.org/our-story/our-story

VCU Medical Center. (2018). 2013 Annual Report. Retrieved from https://annualreports.vcu.edu/archive/medical/2013/stories/safetyfirst.html

White, M., Butterworth, T. & Wells, J.S. (2017). Healthcare Quality Improvement and Work Engagement: Concluding Results from a National, Longitudinal, Cross-sectional Study of Productive Ward-Releasing Time to Care Programme, BMC Health Services Research, 17, 510. Doi: 10.1186/s12913-017-2446-2

 

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Quality Improvement Initiatives

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Quality Improvement Initiatives

You have been asked to prepare and deliver an analysis of an existing quality improvement initiative at your workplace. The QI initiative you choose to analyze should be related to a specific disease, condition, or public health issue of personal or professional interest to you. The purpose of the report is to assess whether specific quality indicators point to improved patient safety, quality of care, cost and efficiency goals, and other desired metrics.

Your target audience consists of nurses and other health professionals with specializations or interest in your selected condition, disease, or issue. In your report, you will define the disease, analyze how the condition is managed, identify the core performance measurements used to treat or manage the condition, and evaluate the impact of the quality indicators on the health care facility:

Note: Remember, you can submit all, or a portion of, your draft to Smarthinking for feedback, before you submit the final version of your analysis for this assessment. However, be mindful of the turnaround time for receiving feedback, if you plan on using this free service.

The numbered points below correspond to grading criteria in the scoring guide. The bullets below each grading criterion further delineate tasks to fulfill the assessment requirements. Be sure that your Quality Improvement Initiative Evaluation addresses all of the content below. You may also want to read the scoring guide to better understand the performance levels that relate to each grading criterion.

  1. Analyze a current quality improvement initiative in a health care setting.
    • Evaluate a QI initiative and explain what prompted the implementation. Detail problems that were not addressed and any issues that arose from the initiative.
  2. Evaluate the success of a current quality improvement initiative through recognized benchmarks and outcome measures.
    • Analyze the benchmarks that were used to evaluate success. Detail what was the most successful, as well as what outcome measures are missing or could be added.
  3. Incorporate interprofessional perspectives related to initiative functionality and outcomes.
    • Integrate the perspectives of interprofessional team members involved in the initiative. Detail who you talked to, their professions, and the impact of their perspectives on your analysis.
  4. Recommend additional indicators and protocols to improve and expand quality outcomes of a quality initiative.
    • Recommend specific process or protocol changes as well as added technologies that would improve quality outcomes.
  5. Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
  6. Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.

Submission Requirements

  • Length of submission: A minimum of five but no more than seven double-spaced, typed pages.
  • Number of references: Cite a minimum of four sources (no older than seven years, unless seminal work) of scholarly peer reviewed or professional evidence that support your interpretation and analysis.
  • APA formatting: Resources and citations are formatted according to current APA style and formatting.

 

CONTEXT:

The purpose of the report is to assess whether specific quality indicators point to improved patient safety, quality of care, cost and efficiency goals, and other desired metrics. Nurses and other health professionals with specializations and/or interest in the condition, disease, or the selected issue are your target audience.

 

QUESTIONS TO CONSIDER:

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

Reflect upon data use in your organization as it relates to adverse events and near-miss incidents.

  • How does your organization manage and report on adverse events or near-miss incidents?
  • What data from your organization’s dashboards help inform adverse events and near-miss incidents?
  • What additional metrics or technology are you aware of that would help ensure patient safety?
  • What changes would you like to see implemented to help the interprofessional team better understand data use and data trends as quality and safety improvement tools?

 

SAMPLE ANSWER

Quality Improvement Initiative Evaluation

            A Quality Improvement (QI) program is a set of activities designed to monitor, analyze and improve the quality of procedures in healthcare facilities in order to improve health outcomes for all stakeholders involved. Despite their proliferation, QI initiatives take place in the background and are incorporated in the organization’s day-to-day activities (Abrampah et al. 2018). Often times, patients never realize that a QI program is in effect. QI initiatives are critical because they strive to improve outcomes for patients, maintain staff efficiency and reduce waste due to process failures. Effective QI programs have set targets that focus on improving safety, effectiveness, access and are patient-centered (Abrampah et al. 2018). Additionally, effective QI programs always align their priorities with the organization’s strategic plan and provide detailed key performance indicators to track progress towards goal achievement.

In line with its goal of improving operations and reducing wastage, Bethany health center initiated the “no to tubes” program focused on reducing the use of catheters in the facility. After conducting an annual audit of the facility’s operations, the health center realized that catheters were being given to patients who did not need them. More alarming than that was the fact that these catheters were being left in for longer periods of time. In line with this realization, the facility developed the “no to tubes” program with the aim of reducing the increasing number of catheter-associated urinary tract infections (CAUTI) caused by catheters that are left in for too long. In addition, the QI program aimed at reducing resource wastage and improving overall operations at the facility. Using the “no to tubes” QI program as an example, the report will assess how specific quality indicators improve patient outcomes, reduce costs and improve organizational efficiency.

Analysis of the Quality Improvement Initiative

The “no to tubes” QI initiative was designed to reduce the occurrence of CAUTI at

Bethany Health Center. Over the following couple of months, the facility implemented a new system of nursing documentation and clinician orders. The nursing documentation system ensured that the patients who needed catheters received them and when the time came for them to be removed, the system would send alerts to nurses prompting them to remove the catheters. The initiative successfully reduced CAUTI rates in the facility from 3.2 per month to less than 1 per month. In addition to implementing the nursing documentation system, the nurses carried out regular and systemic check-ins. The check-ins further reduced infection rates and improved overall quality of care. To further reduce infection rates at the facility, the “no to tubes” initiative implemented an electronic health record catheter identification system, interdisciplinary training was also conducted and clinician education heightened. Measuring the rate of CAUTI is challenging and resource intensive. To mitigate the challenges, Bethany Health Center implemented an electronic CAUTI surveillance system. The system monitored the presence of urinary catheters and fever in patients and used natural language processing (NLP) to include subjective symptoms which were documented in clinical notes (Sanger et al. 2017).

Quality Improvement Initiatives

To evaluate the “no to tubes” initiative, the analysis will use benchmarks and outcome measures.

Evaluation of the QI Initiative through Recognized Benchmarks and Outcome Measures

Quality of healthcare initiatives is usually assessed by using processes and outcome measures. Measuring outcomes of QI initiatives facilitates the decision-making process and improves public accountability (Kampstra et al. 2018). The key feature of benchmarking is to integrate with comprehensive quality improvement policies. Additionally, benchmarking involves measuring results and comparing them to set standards to evaluate organizational performance. There are two key benchmarking activities that Bethany Health Center employed to measure the results of the “no to tubes” initiative. They include: internal benchmarking which identifies best practices in the organization and compares them to the current initiative; external or competitive benchmarking that involves the use of comparative data between healthcare facilities to gauge performance of the initiative and identify areas for improvement (Lovaglio, 2014). Patient quality has always been at the forefront of all the activities at Bethany Health Center. It is with this goal in mind that the facility has successfully implemented previous QI initiatives and used them to benchmark the “no to tubes” initiative.

Outcome measures are changes in the health of individuals, groups of people or populations that are attributed to interventions or series of interventions by the healthcare facility. Effectiveness of care outcome measures evaluate compliance with the best care practices and analyzes achieved outcomes (Kampstra et al. 2018). After implementing the nursing documentation system and the CAUTI surveillance system, Bethany Health Center experienced reduced rates of CAUTIs. Additionally, patient-reported outcome measures (PROMs) were used to measure patient experiences. The patient’s experiences and their perceptions about the care they received at the facility were analyzed. The results showed that patients were generally satisfied with the “no to tubes” initiative and the care they received from healthcare professionals at the facility.

Quality Improvement Initiatives

Interprofessional Perspective on Initiative Functionality and Outcomes

Interprofessional collaboration occurs when healthcare workers from different professional backgrounds unite and work together with patients, their families and the community to deliver high quality care (Garth et al. 2018). Interprofessional teamwork is a core clinical skill that identifies the benefits of collaboration to address the unmet needs of healthcare systems. With the goal of integrating quality improvement and maintaining patient safety efforts with graduate medical education, Scottsdale Healthcare facility participated in the Alliance of Independent Academic Medical Centers (AIAMC) National Initiative IV between 2013 and 2015. The AIAMC implemented several initiatives to reduce unnecessary use of urinary catheters in hospitals. The initiative focused on a multidisciplinary medical education conference that centered on CAUTI prevention (Bell, Alaestante & Finch, 2016). In addition, the facility embarked on the emergency department initiative that saw emergency department nurses and physicians receive intensive education on the reduction of urinary catheter use. Patient tracking was also involved in the initiative and the patients who had urinary catheters were tracked and the information uploaded in the nursing staff daily management system. The results of the initiative show that by incorporating all the stakeholders, Scottsdale Healthcare facility saw a dramatic decrease in urinary catheter insertions and an overall decline in CAUTI cases (Bell, Alaestante & Finch, 2016). The study results further prove that interdisciplinary interaction and collaboration in healthcare further improve patient outcomes and reduce the spread of infections.

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The “no to tubes” initiative would benefit from analyzing staff perspectives towards CAUTI. According to an analysis carried out by Niederhauser at colleagues (2018), there are significant changes in staff perceptions after the implementation of evidence-based interventions. Efforts should therefore be directed towards sustaining the changes so that the intervention implemented becomes an integral part of the organization’s culture. To maintain this culture, staff knowledge about the intervention, their perception of current practices, self-reported responsibility and behavior determinants should be regularly assessed (Niederhauser et al. 2018). To further strengthen the “no to tubes” initiative and obtain the best results, Bethany Health Center should implement a multimodal bundle of interventions that incorporates an evidence-based intervention, daily re-evaluation of catheter use, training and education of all healthcare providers.

Additional Indicators and Protocols to Improve Quality Outcomes

By introducing a nursing documentation system and an electronic health record catheter identification system and encouraging a culture of interdisciplinary training and education, Bethany Health Center has successfully reduced the rate of CAUTI infections and has improved overall quality of care offered to patients. While both the internal and external benchmarking tools have been used to gauge success of the “no to tubes” initiative, additional indicators of quality can improve quality outcomes. The goal of healthcare systems is to improve the quality of care they offer to patients. Successful quality improvement might be challenging. However, by implementing key essentials of success quality improvement can be maintained.

Quality Improvement Initiatives

The first requirements is that health facilities should have a culture of adaptive leadership and governance. Individuals within the health system should have the aptitude to make continuous improvements. Likewise, staff members should be dedicated to the organization and its goals. However, individual efforts are not enough to sustain quality (Tinker & Hough, 2016). There needs to be senior leadership support, an adaptive learning culture and data-driven initiatives for quality improvement. Analytics is a crucial ingredient used to sustain quality in the quality improvement lifecycle. Analytics is incorporated into baseline measurements, problem descriptions and system implementation processes. Analytics should never be mistaken for measurements. The third and critical essential to improve quality is the adoption of evidence and consensus-based best practices. Evidence-based practices are the foundation upon which best practices that improve quality are built (Tinker & Hough, 2016). While the aforementioned practices are designed to improve quality, they will not be successful unless resources are dedicated to implement outcome initiatives. Bethany Health Center should set aside resources towards performance evaluation practices and organizational incentives.

The Lean Six Sigma model is a combined toolkit that provides a systemic approach to help organizations improve their problem-solving skills. The model is based on a scientific method that supports organizations that are looking to improve their problem-solving culture (Lighter, 2014). By adopting the Lean Six Sigma model, Bethany Health center will be able to streamline the “no to tubes” initiative results and improve patient satisfaction levels. Additionally, the model will help the facility engage staff members, improve staff morale and standardize processes. The model will also help the facility better understand the current state of affairs and remove barriers to success. The model focuses on eliminating defects, improving patient safety and maintaining quality. By using the Define-Measure-Analyze-Improve-Control five-step process improvement structure, the Lean Six Sigma model improves patient experiences and makes sure processes consistently deliver desired results (Lighter, 2014).

Quality Improvement Initiatives

Conclusion

Despite their importance and proliferation, quality improvement initiatives often go on in the background and are integrated into the day-to-day operations of healthcare facilities. Quality improvement initiatives are the primary means for improving operations and maintaining high quality care. QI initiatives like the “no to tubes” initiative designed to reduce the rate of CAUTIs set targets aimed at improving patient safety, access to care and guarantee delivery of effective and patient-centered care. To ensure success of QI initiatives, healthcare facilities must evaluate their effectives by using recognized internal and external benchmarks and outcome measures. To reduce the risk of failure, QI initiative must incorporate interprofessional perspectives and set protocols and indicators that are relevant to the implemented QI initiative. Lastly, evidence-based models like the Lean Six Sigma model will help healthcare facilities eliminate defects and maintain staff morale.

 

 

References

Abrampah, N.M. et al. (2018). Quality Improvement and Emerging Global Health Priorities. International Journal for Quality in Health Care, 30(suppl 1), 5-9. Doi: 10.1093/intqhc/mzy007

Bell, M.M., Alaestante, G. & Finch, C. (2016). A Multidisciplinary Intervention to Prevent Catheter-Associated Urinary Tract Infections using Education, Continuum of Care and System wide Buy-in.  The Ochsner Journal, 16(1), 96-100. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795513/

Garth, M., Millet, A., Shearer, E. et al. (2018). Interprofessional Collaboration: A Qualitative Study of Non-Physician Perspectives on Resident competency. Journal of General Internal Medicine, 33(4), 487-492. Doi: 10.1007/s11606-017-4238-0

Kampstra, N.A. et al. (2018). Health Outcomes Measurement and Organizational Readiness Support Quality Improvement: A Systematic Review. BMC Health Services Research, 18(1005). Doi: 10.1186/s12913-018-3828-9

Lovaglio, P.G. (2014). Benchmarking Strategies for Measuring the Quality of Healthcare: Problems and Prospects. The Scientific World Journal Volume, 13. Doi: 10.1100/2012/606154

Lighter, D.E. (2014). The Application of Lean Six Sigma to Provide High-Quality, Reliable Pediatric Care. International Journal of Pediatrics and Adolescent Medicine, 1(1), 8-10. Doi: 10.1016/j.ijpam.2014.09.009

Niederhauser, A., Zuillig, S., Marschall, J. et al. (2018). Change in Staff Perspectives on indwelling Urinary Catheter use after Implementation of an Intervention Bundle in Seven Swiss Acute Care Hospitals: Results of a before/after Survey Study. BMJ Open, 9(10). Doi: 10.1136/bmjopen-2018-028740

Sanger, P.C., Granich, M. et al. (2017). Electronic Surveillance for Catheter-Associated Urinary Tract Infection Using Natural Language Processing. AMIA Annual Symposium Proceedings, 1507-1516. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977673/

Tinker, A. & Hough, L. (2016). The Top Five Essentials for Outcomes Improvement. Health Catalyst. Retrieved from https://www.healthcatalyst.com/outcomes-improvement-five-essentials

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Strategic goal statements and outcomes

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Strategic goal statements and outcomes

Note: You will use your care setting environmental analysis as the basis for developing your strategic plan in this assessment.

Preparation

The feedback you received on your care setting environmental analysis has been positive. Consequently, you have been asked to select one of the potential improvement projects you noted in your analysis and create a full, 5–10-year strategic plan to achieve the desired quality and safety improvement outcomes. You will develop your strategic plan, using either an AI approach (addressing the design stage), or by building on your SWOT analysis and applying a strategic planning model of your choice.

How you structure your plan should be based on whether you are taking an appreciative inquiry approach or using a specific strategic planning model. Regardless of the approach you choose, the requester of the plan has asked that you address the key points outlined below in the strategic plan requirements. In addition, your plan should be 5–8 pages in length.

Note: Remember, you can submit all, or a portion, of your draft plan to Smarthinking for feedback before you submit the final version for this assessment. However, be mindful of the turnaround time for receiving feedback, if you plan on using this free service.

Strategic goal statements and outcomes

Requirements

Note: The requirements outlined below correspond to the grading criteria in the scoring guide, so at a minimum, be sure to address each point. In addition, you are encouraged to review the performance level descriptions for each criterion to see how your work will be assessed.

Writing, Supporting Evidence, and APA Style
  • Write clearly, with professionalism and respect for stakeholders and colleagues.
  • Integrate relevant sources of evidence to support your assertions.
    • Cite at least 3–5 sources of scholarly or professional evidence.
  • Format your document using APA style. An APA Style Paper Template and associated tutorial, linked in the Resources, are provided for your use. Be sure to include:
    • A title page and reference page. An abstract is not required.
    • A running head on all pages.
    • Appropriate section headings.
    • Properly formatted citations and references.
  • Proofread your writing to minimize errors that could distract readers and make it more difficult to focus on the substance of your analysis.

Strategic Plan

  • Develop strategic goal statements and outcomes that reflect specific quality and safety improvements for your care setting. You should have at least one short-term goal (just-in-time to one year) and one long-term goal (five years or longer).
    • Determine realistic timelines for achieving your goals.
    • Explain how your short-term goals support your long-term goals.

Note: For plans based on an AI approach, the goal statements and outcomes are provocative propositions that may be refinements of the positive, yet attainable, goals that you proposed during the dream phase of your inquiry. For plans based on a SWOT analysis, the goal statements and outcomes are specific, measurable, and applicable to the area of concern in your analysis for which you proposed pursuing improvements.

Strategic goal statements and outcomes

  • Justify the relevance of your proposed strategic goals and outcomes in relation to the mission, vision, and values of your care setting.
  • Analyze the extent to which your strategic goals and outcomes, and your approach to achieving them, address:
    • The ethical environment.
    • The cultural environment.
    • The use of technology.
    • Applicable health care policies, laws, and regulations.
  • Explain, in general, how you will use relevant leadership and health care theories to help achieve your proposed strategic goals and outcomes.
    • Consider whether different theories are more applicable to the short-term or long-term goals of your strategic plan.
  • Evaluate the leadership qualities and skills that are most important to successfully implementing your proposed plan and sustaining strategic direction.
    • Identify those leadership qualities and skills that are essential to achieving your goals and outcomes and sustaining strategic direction.
    • Identify those leadership qualities and skills that will have the greatest effect on the success of your plan.

QUESTIONS TO CONSIDER:

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

Strategic planning models aid in setting goals, establishing time frames, and forging a path toward achieving those goals. Consider the strategic planning models you are familiar with:

  • Which model would you choose to create goals and outcomes that could address the area of concern you identified in your Assessment 1 SWOT analysis?
  • Why is this model the best choice among alternatives?
  • How does goal setting through appreciative inquiry provocative propositions differ from goal setting in the strategic planning model you selected?

 

SAMPLE ANSWER

Strategic Planning

Introduction

Selection of an ideal strategic plan involves establishing attributes that define its contribution to solving a target crisis. In this case, the objective of the strategic plan is to improve quality of healthcare and advance safety prospects in a healthcare institution. As a result, the input of the selected strategic plan comprises of the potential possibility of enhancing service delivery while ensuring the protection of interests shared by parties involved. According to Wolf and Floyd (2017), a strategic plan should focus on aspects such as operation depth, resource availability, and ease of policy implementation. Hence, deciding on an ideal strategic plan involves evaluating the demand for resources and the practicability of attached ambitions. Most healthcare organizations would further reflect on the nature of support associated with the model while aligning expectations on the performance perspectives and input of validated service models.

Developing Strategic Goal Statements and Outcomes

Deciding on a strategic plan involves appreciating depth of developed deliverables concerning the expectation and execution of the project. Perspectives such as identification of areas of need, formulation of implementation plan, and subsequent appraisal of enforcement mechanism would allow attainment of established execution period (Noble & Nwanekezie, 2017). However, impression of the strategic plan extends beyond expectations of performance to include further perspectives such as formulating anticipated outcomes through the input of appraisal mechanisms.

Strategic goal statements and outcomes

The main strategic goal of the strategic plan is to improve quality of healthcare and advance safety prospects in a healthcare institution. The plan would involve appreciating depth of concerns in regards to implementation of operational tactics and subsequent improvement of healthcare needs. Wolf and Floyd (2017) support those introducing requirements that assist in achieving to improve quality healthcare and increase patient safety in the healthcare institution. In the current case, since conditions associated with the plan include safety and quality, their attainment involves advancing skills of the staff through training as well as improving available resources (Newman, 2016). Thus, the strategic plan would ensure improved aspects in features such as healthcare delivery and provision of health care services. The organization would provide nurses and physicians with skills that match the expectations of required services (Wolf & Floyd, 2017).

There are weaknesses and gap that would affect setting the long-term and short-term goals. Some of the factors to consider include the level of technology, customer relations and quality of management in the organization. Besides, getting to know your competitors’ investment level is also critical when setting the future goals of a company. The level of investment in the goals should be higher than that of the competitors in order for the organization to have a competitive advantage. Thus, setting realistic and achievable goals based on the competition, current goals of the organization and the recent results and trends is important.  Involving the company’s lower level manager and employees into decision making may prove to be important in developing strategies that can ensure the company achieves the long term and short-term goals.

Long-Term and Short-Term Goals

The long-term goal is to improve the quality and safety of health care services. The main derivable is to improve safety levels and improve service quality based on the mission and vision of the company. The mission statement aims to provide quality patient care with implacable attention to an unparallel commitment and passion, patient safety, and clinical excellence in order to provide the best health care services. The vision statement is to provide supportive and excellent health care services, that enrich patient’s life in terms of safety, holistic care, and quality care and services.
It is important to consider a variety of factors that might affect the achievement of the set goals. Considering the information given by the senior management and employees during benchmarking may be critical in setting future goals that would guarantee organizational performance and success. The recent results and trends of the company should be used to develop future goals. For example, the statement of financial position of the organization can help in setting goals that are measurable, achievable and realistic by ensuring that they are not beyond the company’s capabilities to attain them. Therefore, if the organization is not updated on the trends, it may end up setting future goals that are difficult to achieve.

Strategic goal statements and outcomes

The short-term goal that would guide the strategic plan includes

  1. Study quality challenges in healthcare delivery
  2. Study safety challenges in healthcare delivery
  • Develop possible solutions
  1. Identify a team to implement developed solutions.
  2. Test efficiency of the team
  3. Test comprehension for the task
  • Improve productivity through training nurses
  • Promote access to quality services
  1. Involve stakeholders as part of the project

Timelinefor Achieving Goals

Efficiency of the developed strategic plan manifests the appraisal mechanism that allows possibility of making adjustments while ensuring set performance goals are attained. Ideally, implementation process would follow a cyclic model that spans across the ten years of execution. Each complete cycle will take 40 months to complete, with their distribution across the four phases of strategic plan taking a 1:1:2:2 ratio models. The short-term goals would help to integrate the expectations of practitioners and health care administration through a continuous exchange of feedback. Baumgartner and Rauter (2017) assert that feedback would allow realization of prospective attributes such as insight development and expectations of performance by respective practitioners. Adjustments in goals such as allow the participating teams stakeholders to focus on implementation criterion, would help to achieve the achieving the strategic results (Baumgartner & Rauter, 2017). Modeling such expectations on the demands of health care facility would allow the eventual attainment of routine long-term goals and objectives associated with the strategic plan.

Perspectives, which include the outcomes and their relation to established deliverables, tend to manifest through detailed evaluation of the plan. At the same time, an appraisal of the project through a SWOT analysis allows visualization of its potential additions towards realization of elemental objectives of quality and safety.

SWOT Analysis of the Strategic Plan

The strategic plan may need to reflect on expectations of the health care facility, along with features of quality and safety. As a result, SWOT analysis of the plan would reflect on expectations of each input along with the two models. According to McDonald (2016), proposing adjustments along such dynamics allow appreciation of the potential associated with the task and adopted strategic plan. A further reflection on interlocking dynamics of quality and safety enables visualization of the ideal input of the project from an operational perspective. Concepts geared towards attainment of the program need to manifest their interchange potential when reflected against aspects such as quality and safety.

Strength

The strengths of the identified strategic plan manifest through the input of advanced study on the challenges and the availability of adequate resources to address their management. In essence, the strategic plan comprises a testing phase that assists in identification of shortcomings of the effective solution, along with dynamics of quality and safety. Also, the ratio adopted in guiding implementation model allows allocation of adequate time to involve phases such as execution and testing.

Weakness

The plan comprises of time-consuming phases that challenge the effectiveness of the implemented measures. Additionally, the input of ideal strategic data, such as the need to identify a reliable team may face challenges of obsoleteness during execution due to changes in the expected outcomes. Ideally, such changes may manifest from the advances in the industry. Similarly, the plan does not focus on redefining the execution process about changes associated with the external environment.

Opportunity

The concern of adjustment rigidity stands to benefit from the autonomous prospects associated with each phase. Primarily, the operations within a period involve inputs that distinguish the implementation course along a zoned process. Thus, the operations of each stage only fetch guidance from the previous phase. As a result, there exist viable possibilities of making adjustments through invoking fast-tracked modifications through the earlier steps. The engaged changes would then initiate the execution phase as structural or operational adjustments.

Threat

The implementation of the suggested strategic plan faces the threat of inadequate resources, which may lead to the potential inclusion of incompetency elements during execution. Arguably, the concern of resources manifests during the commissioning of the plan’s actualization phase. However, the issue remains relevant after the development phase since the strategic plan suggests different inputs to redefine the solution development and established deliverables.

Strategic goal statements and outcomes

The Relevance of the Proposed Strategic Goals and Outcomes

The main goal in a healthcare setting is to provide the best treatment interventions and promote meaningful outcomes thus improving the quality of life. To improve the safety and quality of goals in a healthcare setting, essential components for quality improvement programs must be considered. For the goals to be attainable they have to be safe, equitable, efficient, and be centered on patient needs. The goals will ensure high-quality medical services. This is another positive aspect of the healthcare clinic. Therefore, the need for the plan is to ensure that the main aspects and dimensions get achieved. It, therefore, increases the need to improve the quality of healthcare and reduce the readmission of patients, improve patient satisfaction, ensure patients are not left without being seen, ensure cleanliness and quietness of hospital, reduce outpatient wait time, reduce clinical error ratios, and reduce occurrence of hospital-acquired infections, within different departments within the organization.

The Ethical, Cultural, Technological Environment and Applicable Health Care Policies, Laws, and Regulations

Cultural diversity is a critical factor that must be considered when caring for patients. The health care facility would consider the concept of cultural competence to guarantee patient collaboration with the nurses during treatment to improve the company’s rate of underperformance (Dreachslin et al., 2017). The strategic goals would improve cultural competency since diversity of the patients within the organizations would be critical in providing quality and safety care. However, a lack of a sustainable culture that guarantees cultural competence and lack of cultural beliefs and values of patients would influence effective delivery of care and achievement of the strategic goals.

Strategic goals and outcomes will also ensure the confidentiality, ethics, and feasibility of the treatment process (Dreachslin et al., 2017). The health care institution must figure out how issues around care of patients and their privacy, consent, and the operability of the intervention to reduce the readmission rate in the organization. However, lack of informed consent and autonomy of patients may influence the strategic goals since nurses are required to ensure ethical practices during healthcare delivery.

The strategic goals and outcomes will be ensured through implementing EMR system as a Health Information Technology in the health care institution. EMR helps to manage patient’s information, including medical history and treatment, which will meet the objectives of quality and safety.  However, lack of cooperation and technical training of nurses and physicians on how to use the EMR system to improve healthcare delivery may influence the achievement of strategic goals.

The Public Health Act advocates for quality and holistic care from both the local and state government in order to improve quality of life (Health, 2018).  Besides both the local and state government are tasked with funding healthcare institutions, and developing policies that assesses and evaluates patients’ outcomes, which are based on federal and local government goals (Health, 2018).  Therefore, healthcare delivery must be aligned to legal and ethical standards based on the federal, state, and local legislations to act as an oversight to ensure all the strategic goals and outcomes are achieved.

Relevant Leadership and Health Care Theories to Help Achieve Proposed Strategic Goals and Outcomes

Relevant leadership and health care theories can help achieve proposed strategic goals and outcomes in the organization. Theories ought to be related to explicit petitions as well as mediation segments to be actualized in the plan. The tools selected also need to coordinate negotiations and link back to the theory.

Transformational leadership is the leading theory that will help achieve proposed strategic goals and outcomes in the organization. The theory was developed by James MacGregor Burns (Wolf& Floyd,2017). The theory states that transformational leadership links the leaders and their supporters to ensure they cooperate and support each other to bring about respectful relation between the leader and the follower.  MacGregor Burns also provides critical issues that were provided by Bernard M. Bass, who consider that transformational leaders should be visionary. Leaders must urge their followers to change their motivations, suppositions, and desires to ensure they share similar goals and objectives to improve health care delivery (Wolf & Floyd, 2017).  MacGregor mentioned that original thought, scholarly incitement, solid inspiration, and perfect effect are the main parts of transformational leadership that can help improve the quality and safety of care (Wolf& Floyd, 2017).

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Participative leadership or vote based leadership is another leadership theory that can help achieve proposed strategic goals and outcomes in the organization. The theory requires followers to take interest in leadership positions and ensure everything goes as planned (Wolf& Floyd, 2017). The style of leadership is primarily used in organizations such as educational institutions, health care institutions, pharmaceutical firms, and data innovation organizations. Therefore, the theory encourages the nurses and physicians to share their thoughts and objectives on the path the leadership should follow. Researchers have shown that nurses and physicians who are part of participative leadership style are capable of performing their roles and responsibilities efficiently.

Transactional leadership is based on developing specific objectives and goals to spur supporters and empower them towards a course (Xu, 2017). The theory considers that leaders and their teams of employees or followers enter an agreement by giving rewards to the most performing team members by offering virtually a check in return, time off, compensation, and benefits.  In cases where the goals are not met, the leadership uses negative rewards such as providing severe punishment for team members who do not complete their duties. Thus, transformational leadership considers that leadership desires should be achieved by their devotees to keep up their vision and social standard being pursued (Wolf & Floyd, 2017). Transactional leadership also portrays duties and desires of the leaders and devotees. Likewise, the style guarantees that the way of life inside a unit is kept up, with the guidelines and social standards carefully pursued to help achieve proposed strategic goals and outcomes in the organization.

Strategic goal statements and outcomes

The major gap of transformational leadership and transactional leadership theory are that the relationship between the leader and the follower may lead to power struggles and oppositions, which reduce the value system congruence between the leader and the follower. Evidence has shown that transformational leadership requires agents to convince people about a shared vision, without which followers may lack motivation to achieve their goals. Building a connection of trust with their followers may not be established if the leadership is not open, fair, and honest, and does not involve them in decision-making processes.

When comparing the two theories, it is important to note that participative leadership has low motivation, and it takes a long time for decision-making (Xu,2017). On the other hand, transactional leadership theory cannot be successful without providing positive rewards such as a bonus, time off, health benefits, or simply a paycheck in exchange for the completion of a task.

Leadership Qualities and Skills Important for the Proposed Plan

Assessing the leadership characteristics and abilities that will be most critical to executing a strategic plan effectively is essential to guarantee that strategic plans are effectively actualized. There are necessary abilities and characteristics that leaders must have to set up a reasonable and crucial strategic planning process (Wolf & Floyd, 2017). McDonald (2016) considers that leaders should have a strong vision and personality to motivate their followers to adjust expectations, opinions, and inspirations to work toward common goals.  Leaders should act as facilitators rather than dictators to facilitate idea generation and sharing of information with the end goal of arriving at a decision. Besides, leaders should involve followers in the decision-making process, while still maintaining control. Leaders need to be open, fair, and honest with the staff and by motivating them to be independent in their decision-making (Wolf & Floyd, 2017). This impacts follower satisfaction and commitment to the organization. Leaders must also use effective communication to lead the staff to achieve ultimate goals. Lastly, leaders should possess great self-confidence to firmly believe in their vision (Wolf & Floyd, 2017). Thus, the leadership qualities and knowledge will help improve patient outcome through the provision of quality care and ensure patient safety.

Strategic goal statements and outcomes

Conclusion

Building up a dependable strategic plan includes recognizing the directing target to aid the assurance of the long-haul expectations. Deciding on an ideal strategic plan also involves evaluating the demand for resources and the practicability of the attached ambitions. Projections concentrating on the desires for security and nature of the offered administrations permit the enrolling of a practical procedure towards execution dependability. Viewpoints, for example, time and other substantial assets, would help with deciding the destinations to list under each period of the strategic plan. In any case, accomplishing the whole procedure would include valuing the elements of the administration conveyance strategy while analyzing the potential zones requiring conceivable modifications. Without a doubt, an effective strategic plan contains routine testing of the result as well as making adjustment through a full usage cycle.

 

 

References

Baumgartner, R. J., &Rauter, R. (2017). Strategic perspectives of corporate sustainability management to develop a sustainable organization. Journal of Cleaner Production, 140, 81- 92. Doi: 10.1016/j.jclepro.2016.04.146.

Dreachslin, J., Weech-Maldonado, R., Jordan, L., Gail, J., & Epané, J. P. (2017). Blueprint for Sustainable Change in Diversity Management and Cultural Competence: Lessons From the National Center for Healthcare Leadership Diversity Demonstration Project. Journal of Healthcare Management, 171-185.

Health, M. D. (2018, January 24). Local Public Health Act. Retrieved from http://www.health.state.mn.us/divs/opi/gov/lphact/

McDonald, M. (2016). Strategic marketing planning: Theory and practice. In M. J. Baker, & S., Hart (Eds.), The marketing book (7th ed., pp. 86-120). New York, NY: Routledge.

Noble, B., &Nwanekezie, K. (2017). Conceptualizing strategic environmental assessment: Principles, approaches, and research directions. Environmental Impact Assessment Review, 62, 165-173. Doi: 10.1016/j.eiar.2016.03.005.

Wolf, C., & Floyd, S. W. (2017). Strategic planning research: Toward a theory-driven agenda. Journal of Management, 43(6), 1754-1788. Doi: 10.1177/014920631347818

Xu, J., & Xu, L. (2017). Fault Diagnostics. Integrated System Health Management, 247-317. Doi:10.1016/b978-0-12-812207-5.00006-7

 

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Environmental analysis in the healthcare system

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Environmental analysis in the healthcare system

You have been asked to conduct an analysis of your care setting that will result in two potential pathways toward a strategic plan to improve health care quality and safety in your organization, department, team, community project, or other care setting. To accomplish this, you will take two approaches to the analysis:

  1. Complete the discovery and dream phases of an appreciative inquiry (AI) project.
  2. Conduct a strengths, weaknesses, opportunities and threats (SWOT) analysis.

To help ensure that your analysis is well-received, the requester has suggested that you:

  • Present your analysis results in four parts:
    • Part 1: Appreciative Inquiry Discovery and Dream.
    • Part 2: SWOT Analysis.
    • Part 3: Comparison of Approaches.
    • Part 4: Analysis of Relevant Leadership Characteristics and Skills.
  • Your analysis should be 4–7 pages in length.

Note: Remember, you can submit all, or a portion, of your draft plan to Smarthinking for feedback before you submit the final version for this assessment. However, be mindful of the turnaround time for receiving feedback, if you plan on using this free service.

Analysis Requirements

Note: The requirements outlined below correspond to the grading criteria in the scoring guide, so at a minimum, be sure to address each point. In addition, you are encouraged to review the performance level descriptions for each criterion to see how your work will be assessed.

Writing, Supporting Evidence, and APA Style
  • Communicate professionally when conducting interviews and collecting data.
  • Write clearly, with professionalism and respect for stakeholders and colleagues.
  • Integrate relevant sources of evidence to support your assertions.
    • Cite at least 3–5 sources of scholarly or professional evidence.
    • Include relevant interview information.
  • Format your document using APA style. The APA Style Paper Template and associated tutorial, linked in the Resources, are provided for your use. Be sure to include:
    • A title page and reference page. An abstract is not required.
    • A running head on all pages.
    • Appropriate section headings.
    • Properly formatted citations and references.
  • Proofread your writing to minimize errors that could distract readers and make it more difficult to focus on the substance of your analysis.
Part 1: Appreciative Inquiry Discovery and Dream
  • Synthesize stories and evidence about times when a care setting performed at its best with regard to quality and safety goals.
    • Collect stories from your care setting. You may collect stories through interviews or conversations with colleagues or provide your own.
    • Explain how your stories are related to quality and safety goals.
    • Describe the evidence you have that substantiates your stories.
    • Identify the positive themes reflected in your stories.
    • Describe other evidence (for example: data, awards, accreditations) that validates your care setting’s positive core.
  • Propose positive, yet attainable, quality and safety improvement goals for your care setting.
    • Explain how accomplishing these goals will lead to ethical and culturally-sensitive improvements in quality and safety.
    • Explain how your proposed goals align with your care setting’s mission, vision, and values.

Environmental analysis in the healthcare system

Part 2: SWOT Analysis
  • Conduct a SWOT analysis of your care setting, with respect to quality and safety goals.
    • Provide a narrative description of your analysis.
    • Identify the assessment tool you used as the basis of your analysis.
    • Describe your key findings and their relationships to quality and safety goals.
  • Describe one area of concern that you identified in your SWOT analysis—relevant to your care setting’s mission, vision, and values—for which you would propose pursuing improvements.
    • Explain how this area of concern relates to your care setting’s mission, vision, and values.
    • Explain why you believe it will be necessary and valuable to pursue improvements related to this area of concern.
Part 3: Comparison of Approaches

Compare the AI and SWOT approaches to analysis and reflect on the results.

  • Describe your mindset when examining your care setting from an AI perspective and from a SWOT perspective.
  • Describe the types of data and evidence you searched for when taking an AI approach and a SWOT approach.
  • Describe the similarities and differences between the two approaches when communicating and interacting with colleagues.
Part 4: Analysis of Relevant Leadership Characteristics and Skills

Analyze the leadership characteristics and skills most desired in the person leading potential performance improvement projects, taking both an AI and SWOT approach.

  • Explain how these characteristics and skills would help a leader facilitate a successful AI-based project and a successful SWOT-based project.
  • Comment on any shared characteristics or skills you identified as helpful for both AI and SWOT approaches.

 

QUESTIONS TO CONSIDER:

 

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

One key aspect to being an effective leader, manager, or administrator is an awareness of your leadership strengths, weaknesses, and style.

  • How would you assess your general leadership, communication, and relationship-building skills?
  • How would describe your leadership style?

Imagine the future for a care setting that is your place of practice or one in which you would like to work.

  • What aspirational goals can you envision that would lead to improvements in health care quality and safety?
  • How well do these goals align with the mission, vision, and values of your care setting?

 

SAMPLE ANSWER

Care Setting Environmental Analysis

Introduction

Conducting an environmental analysis in the healthcare system is an essential part of the strategic planning process of an organization. This tool helps in identifying the possible external and internal elements that may influence the organization’s operations. It also focuses on determining the risks and opportunities that may be available for the organization and the findings from the analysis are considered during the decision-making process (Phadermrod, Crowder, & Wills, 2019). The environment in which the healthcare sector operates has continuously evolved overtime. Various strategic tools can help to analyze the microenvironment of a business. The primary analysis tools include the PESTLE analysis, SWOT analysis, business tool analysis, and microenvironment analysis. All these tools are critical for the accomplishment of the business. This paper analyzes the ABC Health Clinic based on its strategic development, including the discovery and dream phases of an Appreciative Inquiry (AI) project and a strengths, weaknesses, opportunities, and threats (SWOT) analysis of the healthcare institution.

Part 1: Appreciative Inquiry Discovery and Dream

Appreciative Inquiry (AI) represents one of the critical change methods that promise to energize quality management in the healthcare sector. According to MacCoy (2014), whatever the situation one encounters, the first step is always to discover and disclose the situation’s positive capacity. The aim of this stage is to find emphasis and highlight all factors that have led to success in similar cases. The best way to discover the best method is to first look at the peak experiences. However, one should also look at what touches his or her heart and spirit and what motivates him or her to view reality from a different perspective (Bertram, Gilbert, & Culver, 2016). On the other hand, dreaming entails the act of focusing on the possibility of what could be, rather than the limiting factors. In dreams, a person is focused on seeing and understanding things in a new way.

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In healthcare organizations, quality management often seems more like a burden than an opportunity for growth. Such is the situation at ABC Health Clinic. Interviews were conducted among the clinic’s staff who gave their stories about their journey in the hospital. Most of the doctors, nurses, and other hospital staff, about 82 percent, indicated that they were satisfied with their departments of work and the duties assigned to them. They further stated that they were motivated to work in the hospital. Some of the factors that they highlighted as their motivators to work in the hospital included remuneration, working conditions, engagement by the management, and flexible work schedules.

It was reported that nurses at ABC cannot do their jobs without collaboration. When they assign beds and the floors push back, it delays the patients from getting to their assigned room. When discharge orders are not made earlier in the day, beds don’t become available until later in the day. All of these factors have to be done in a timely way for ABC to help improve patient flow.

Environmental analysis in the healthcare system

Nurses also engage with each other and other departments. There are multiple tasks that are split among nurses. Services such as Cardiac, Surgery, Medicine, and Oncology all have to be distributed among several nurses to make sure the hospital’s entire bed board is covered. For patients that are being admitted, nurses work closely together to ensure the patients get appropriate services. Therefore, in order to ensure efficient patient flow, nurses work together. Although each nurse may have individual tasks to perform, the tasks are interrelated and a lot of time they have to collaborate to ensure everything runs smoothly and avoid delays.

In the Dream phase of AI analysis, the findings provided an outlook on the future of ABC on its commitment to patient safety goals. The future of ABC improvement processes is ongoing. The organization will be switching over to a new EMR, which is supposed to make interdepartmental data tracking and patient charting seamless. ABC is also looking to increase staffing and possibly changing locations to a larger office.

Part 2: SWOT Analysis

ABC Health Clinic is a healthcare establishment in which many people in Area B seek medical services. The clinic was established in 1991 and has experienced growth since then. The institution has various units such as the Intensive Care Unit (ICU), the emergency department, burn center, the pediatric department, and many others. People in the area visit the hospital to seek emergency services and other small health issues. Outstandingly, the hospital has some of the most experienced doctors in the area who deliver competent medical attention and treatment plans to their patients’ satisfaction.

ABC’s SWOT Analysis

A SWOT analysis is a standard study tool used to determine the internal strengths and weaknesses of an organization, as well as its external opportunities and risks (Phadermrod et al., 2019). The strengths of any organization account for the positive aspects of the brand. For instance, in our case, ABC’s strengths make it one of the most favorable hospitals in the area.

Strengths

ABC has many capabilities that gives it a huge advantage over the other health care organizations in the state. Examples include the following:

Reputation: The hospital is a nationally recognized healthcare center and exceeds many national benchmarks for safety. This is because of the quality care that ABC offers its’ patients. ABC analyzes trends, such as how long it takes a patient to be admitted, how long physicians spend with patients and the average response time for a transport order. This has positively impacted the emergency department and the organization’s patient safety goals for decreasing wait times and patients leaving without receiving medical care.

Environmental analysis in the healthcare system

Highly qualified and experienced doctors and staff- Doctors and other staff in the hospital are what make the facility the most preferred choice for the people in the area. The hospital has a very complex employment process, which ensures that it hires the most qualified doctors and other hospital staff. This strength is one of the most critical factors that distinguish ABC from other hospitals, not only in the area but also in the entire region.

Brand name- ABC has, over the years, established itself as the most desirable hospital in the area since 1991. It has become popular, not only among the local people but also across the whole region. People travel for hundreds of kilometers to seek medical services at ABC. This brand name has been built through many years of hard work and dedication.

High-quality medical services-This is another positive aspect of the ABC Health Clinic. The two departments that have contributed to this popularity are the emergency department and outpatient section. Most of the emergences in the region are referred to as the ABC Clinic, including road accidents and burns. Other departments have contributed to this popularity, including the ICU, pediatric, and cancer departments.

Weaknesses

According to Phadermrod, Crowder, and Wills (2019), weaknesses refer to the downside in a brand’s services. Although ABC does not have many shortcomings, it has some significant ones that can affect its performance.

Environmental analysis in the healthcare system

A decentralized organizational vision for throughput limits ABC’s goal for improving patient flow for patient safety in the emergency department. Patient flow is not only reliant on ED processes, but is also greatly dependent on occupied inpatient beds. Earlier discharges would alleviate extended wait times for patients in the ED. Until patient flow becomes a central idea to the organization, patient safety due to the long length of stay will remain an unresolved issue.

The high cost of medical services-One of the critical weaknesses of the healthcare facility is its high cost of medical services. Since the clinic has been operational for many years, it is supposed to have addressed the problem of high prices. Even though it provides high-quality services, it should give them at an affordable cost. Some of the services, such as cancer treatment, are provided at costs that are unreachable by many people in the area. This is an issue that the clinic may consider with utmost seriousness since it is located in an area where most people are medium-income earners.

Inadequate staff – Another weakness is that the clinic has inadequate staff. Considering the number of people that visit the hospital in a day, the ratio of doctor to patients is 1:50. Since there are some patients whose medical conditions require a considerable amount of time, the number of doctors in the hospital cannot adequately cater for all patients.

Opportunities

Many hospitals do not offer some of the services that are offered at ABC Health Clinic. This is most likely the reason why many people travel for long distances to seek medical services at ABC clinic. Some of the services offered include cancer treatment and gynecological services. In order for patient flow to work successfully, ABC needs to change the hospital’s current culture of viewing throughput as the responsibility of the ED to one of a hospital-wide responsibility. Throughput needs to be a system-wide objective of every department involved in patient care from admission to discharge. In order for a culture change to be successful, the management should introduce the changes and train the frontline staff how to follow the new process which would enable the hospital transformation.

Environmental analysis in the healthcare system

Threats

In an organization, threats are the external obstacles that stand on the path of its success. The only significant threat for ABC is the new emerging hospitals that are likely to be its competitors in the years to come. Hospitals in the region are increasingly investing in new medical technologies and inventions, and are advancing in terms of service provision. This implies that ABC has to draft strategies to improve its operations and to remain relevant and competitive in the near future. Threats to any healthcare organization with below-average scores in patient safety can affect insurance reimbursement and leave the organization at risk for malpractice lawsuits. A commitment to patient safety is key to avoiding these threats.

Part 3: Comparison of Approaches

The organizational outcomes when SWOT analysis and when AI is used are entirely different. SWOT analysis has a deficient level of engagement compared to AI. The latter collects information by asking questions regarding the strengths and weaknesses of the organization or the issue at hand. It takes into account each set of questions by focusing on more specific areas when collecting diverse perspectives from different members of the team. AI is more result-oriented because it stimulates and encourages positive outcomes (Bertram et Al., 2016).The assumption in this comparison is that the threats and weaknesses are overpowered by the strengths, and that the SWOT analysis in the ABC Clinic is applied the way it is described. The bias in the AI analysis is that it does not consider what the organization should avoid in order to fully uncover the available opportunities.

On the contrary, SWOT is more of a balanced analysis that usually generalizes. Also, the model focuses more on the failures than the achievements. For ABC Clinic, focusing on the negatives may deprive it of its confidence, thus destroying the inspirational vision to work (Bertram, Gilbert, & Culver, 2016). The data collected in the AI approach has led to the focus on positive aspects of the departments as well as on how the staff felt about their job and their contribution to patient safety goals. ABC aims to create a command center, Patient Placement Operation Center (PPOC), a nurse-driven department and serving as patient flow specialists that identify where beds are free and where incoming patients should be placed. These specialists will oversee housekeeping to ensure new beds are ready for patients and coordinate with the transport team tasked with moving patients around the hospital where staff members can more efficiently oversee patient flow. Thus, ABC would reduce patient long wait times and patients leaving without receiving medical attention which creates quality and safety issues for the patients. The patient safety throughput initiatives will ensure improvements in quality care, patient satisfaction and financial returns.

Environmental analysis in the healthcare system

Moreover, with the growing emphasis on evidence-based practices (EBP), uncertainty has become a major factor affecting the healthcare setting. Uncertainty is the main drive for medical researchers, patients’ pursuit for medical care, and medical interventions. However, despite its impact on healthcare, there is still minimal knowledge on how to address the effects it has on the stakeholders of the health sector. These knowledge gaps include the uncertainties encountered by patients and clinicians, the effects of communication barriers, and how to assist them in dealing with the uncertainties. A fundamental way to address the knowledge gaps would be drafting an empirical evidence framework that integrates the concept of uncertainty from various disciplines.

Part 4: Analysis of Relevant Leadership Characteristics and Skills

Leadership is an important aspect, especially in healthcare organizations. Although it is not fundamentally taught in medical schools, hospital leaders are expected to demonstrate high-quality leadership skills to lead their healthcare organizations to success (De Zulueta, 2016). ABC Health Clinic recognizes the importance of engaging its staff in leadership roles. During the interviews, one of the nurses at ABC indicated that every staff in the clinic could lead a team in his or her respective area. This was because the management of the hospital had an obligation to provide its staff with opportunities to develop their leadership skills.

Environmental analysis in the healthcare system

Team leaders were found to have high-quality leadership skills, primarily through their communication. Communication skills promote an understanding between the leaders and their subordinates and between the management and employees (Bertram, Gilbert, & Culver, 2016). ABC staffs are also trained in team-building skills. The group meetings that were conducted to obtain information for the present paper revealed that no staff member dominates others during conversation, implying that each staff member has excellent team-building skills.

Conclusion

The target market for every organization keeps evolving on a daily basis. Technological advancement and the environment are the critical situational factors that mostly determine the outcomes and relevance of an organization against its competitors. Therefore, organizations such as the ABC Health Clinic may incorporate either the AI or SWOT analysis tools to assess its internal and external factors, and draft the best strategies that will aid in realization of objectives. ABC has an opportunity to expand its operations and open branches in other areas to take its services closer to consumers.  However, the organization needs to increase the number of staff to reduce burnout and stress among nurses.  Other motivators for nurses that should be maintained by the company include remuneration, working conditions, engagement by the management, and flexible work schedules.

 

 

References

Bertram, R., Gilbert, W., & Culver, D. (2016). Using appreciative inquiry to create high-impact coach learning: Insights from a decade of applied research. Practitioner. Retrieved from https://www.researchgate.net/publication/303518470_Using_Appreciative_Inquiry_to_Create_High-_Impact_Coach_Learning_Insights_From_a_Decade_of_Applied_Research

De Zulueta, P. C. (2016). Developing compassionate leadership in health care: an integrative review. Journal of healthcare leadership, 8, 1. Doi:10.2147/jhl.s68068

Phadermrod, B., Crowder, R. M., & Wills, G. B. (2019). Importance-performance analysis-based SWOT analysis. International Journal of Information Management, 44, 194-203. Doi:10.1016/j.iheduc.2016.07.001

MacCoy, D. (2014). Appreciative Inquiry and Evaluation – Getting to What Works. Retrieved from https://evaluationcanada.ca/secure/29-2-104_2WUY4UN3XR.pdf

 

 

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The Use of Clinical Systems to Improve Outcomes and Efficiencies

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The Use of Clinical Systems to Improve Outcomes and Efficiencies

WEEK EIGHT INFORMATIC ASSIGNMENT

  •       This is a Masters level paper.
  •       Follow correct APA format for title page
  •       Times New Roman, Font size 12, double spacing, margins, indentations, page numbers
  •       No running head, in-text citations required, and reference list.

 

Instructions

A short introduction with a purpose statement

Body: 4- to 5-page paper addressing the following:

·         Identify the 5 peer-reviewed articles you reviewed, citing each in APA format.

·         Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described.

·         Be specific and provide examples.

Summary

Reference page (Required Five total at least two course resources)

·         Should be five peer review articles not older than 5 years

 

To Prepare:

  • Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.
  • Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.”
  • Identify and select 5 peer-reviewed articles from your research.

The Assignment: (4-5 pages)

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Be sure to address the following:

 

SAMPLE ANSWER

The Use of Clinical Systems to Improve Outcomes and Efficiencies

Clinical systems are integral elements in the healthcare sector. They contribute towards improving the outcomes and efficiencies in service delivery within the elaborate healthcare systems. This paper aims to analyze relevant literature on various clinical systems and how they help in the improvement of outcomes together with effectiveness and efficiency in dealing with health problems.

Rao-Gupta, Kruger, Leak, Tieman, and Manworren (2018) conducted a study on the leveraging of the interactive care technology to bring effective pain management on the patients. The study was primarily to find a way of easing the pain on children while undergoing treatment in the hospitals. The pain management mechanisms in place at the time were unsatisfactory, leading to the development of the clinical care system. The authors were trying to examine how the use of the care system would significantly lead to the improvement of pain management. Consequently, the common understanding is that interactive care technology was integral in easing the pain on the children on its utilization. This led to increased satisfaction in the pain management responses, following the increased effectiveness in the evaluation of treatments and pain assessment.

Nursing Paper Help

The application of the peer-review article by Rao-Gupta et al (2018) brings into perspective the understanding that care technologies are important in making certain care functions manageable. This led to increased overall satisfaction for the families with patient suffering from pain while undergoing treatment. Equally, it is critical for the care facility to be cognizant and sensitive to the pains of both patients and their families as part of the experiences that they give to the general public. This is critical in the appreciation of the role of clinical systems in the management of and support of life. In the study, the use of the pediatric surgical unit patients to conduct the assessment on the effectiveness of the pain management system is vital in bringing a wholesome understanding of the whole perspective. Thus, it goes into record as one creative realization contributing to positive development in the health sector.

The study by Skiba (2017) examines the use of digital systems in the facilitation of healthcare delivery to the public. The digital tools are of critical importance in ensuring that there is an establishment of critical links between care providers and consumers of health services. The clinical systems space provides an avenue for working towards ensuring that health management becomes easy. The assessment of those systems gives a glimpse of what an ideal care system should look like.

The takeaway from the research is that there is an increasing diversity in healthcare courtesy of the invention and innovation of social media and related apps. It has brought effectiveness in health services delivery in the sector. Social media and mobile apps tools have ensured that service delivery takes place across the board. The integration of the applications into the clinical systems has transformed the health sector significantly. A good example of those applications is the myoclonic social media and apps in both Apple and Android stores (Skiba, 2017).

Gabriel, Quaresma, Secca and Vieira (2018) investigated the use of the stereo vision system in conducting an assessment of the spine. The clinical system has overseen the realization of immense changes in the spinal columns, contributing to recovery in the patients. The Vertebra Metrics understanding becomes an essential tool in evaluating the pain aspects. This has led to improvements in dealing with back pains. The clinical system comes an innovation that is contributing to the realization better health. The wholesome understanding of how technology works make the clinical setting effective in the delivery of care.

The Use of Clinical Systems to Improve Outcomes and Efficiencies

The Vertebral Metrics clinical system has been integral in dealing with back pains in patients (Gabriel, Quaresma, Secca & Vieira, 2018). This leads to increased overall efficiency in the offering of health services to patients with issues in the vertebra. The clinical application of the system as a tool for dealing with vertebral issues has brought immense changes in the health sector. The takeaway from the whole undertaking becomes a critical way of gauging the effectiveness of services offered in the health sector, and the far that improvements have come into perspective.

Huang, Goo, Behara and Agarwal (2018) studied the system for the management of COPD-readmission risk. The readmission risk indicator checks on the quality of patient care for those dealing with Chronic Obstructive Pulmonary Disease. Conducting the study using live data made it possible to establish reliable outcomes of the whole process. The whole undertaking enhanced the realization of how the clinical system deals with the issue at hand. In this way, the clinical system goes into records as one of the tools that have managed to achieve its intended purpose in as far as healthcare delivery is concerned.

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The primary lesson of the study is that the clinical support system immensely enhances the reduction of readmission statistics for patients’ dealing with chronic illnesses. Consequently, the whole study reaffirms the importance of the clinical support system. Its efficiency in performing its intended function is unmatched. Essentially, the whole undertaking to apply the system in dealing with chronic ailments for patients in several hospitals helps manage the diseases effectively and efficiency. In this way, the improvement of the outcomes is unavoidable, contributing to the growth and development of the entire health sector. This paves way for continuous improvements and innovations to help improve the health sector. In their study, Huang, Goo, Behara, & Agarwal (2018) have found that the readmission risk, which was problematic in the past, has slowly faded due to the clinical system in place.

Safdari, GhaziSaeedi, Masoumi-Asl, Rezaei-Hachesu, Mirnia and Samad-Soltani (2018), in their review study, focus critically on the antimicrobial resistance surveillance systems applicable in the clinical settings. The systems work through the integration of diverse elements. In this way, they are in a position to achieve their functionality largely. This helps put mechanisms in place to deal with the resistance, which is a public health menace in many countries.

The Use of Clinical Systems to Improve Outcomes and Efficiencies

The study is a success courtesy of the fact that it manages to reveal how the resistance surveillance system help deal with the problem (Safdari, et al., 2018). Essentially, the whole review reveals to a large extent the importance of the antimicrobial resistance surveillance system. In this way, it becomes possible to evaluate other ways of handling the issue at hand. The effectiveness and efficiency that comes with putting in place the right mechanisms for dealing with the problem. This makes innovativeness and creativity in the health sector at its peak.

In conclusion, the review of the relevant literature gives a brief overview of what the authors examine. The subsequent lessons from the study contribute towards the understanding of how the clinical systems are of critical importance in the whole undertaking. This is critical in working towards ensuring that there is a check of the whole health sector to ensure that it offers the relevant services to the intended level. In this way, it becomes possible to appreciate the role of the health sector in enhancing lives.

 

 

References

Gabriel, A. T., Quaresma, C., Secca, M., & Vieira, P. (2018). Development and clinical application of vertebral metrics: Using a stereo vision system to assess the spine. Medical and Biological Engineering and Computing, 56(8), 1435-1446. Doi: 10.1007/s11517-018-1789-0

Huang, C. D, Goo, J., Behara, R. S., & Agarwal, A. (2018). Clinical decision support system for managing COPD-related readmission risk. Information Systems Frontiers, 1-13. Doi: 10.1007/s10796-018-9881-4

Rao-Gupta, S., Kruger, D. Leak, L. D., Tieman, L. A., & Manworren, R. C. B. (2018). Leveraging interactive patient care technology to Improve pain management engagement. Pain Management Nursing, 19(3), 212–221. Doi: 10.1016/j.pmn.2017.11.002

Safdari, R., GhaziSaeedi, M., Masoumi-Asl, H., Rezaei-Hachesu, P., Mirnia, K., & Samad-Soltani, T. (2018). Knowledge discovery and visualization in antimicrobial resistance surveillance systems: A scoping review. The Artificial Intelligence Review, 1-38. Doi: 10.1007/s10462-018-9659-6

Skiba, D. (2017). Evaluation tools to appraise social media and mobile applications. Informatics, 4(3), 32–40. Doi:10.3390/informatics4030032

 

 

 

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Global Health Comparison and Narrative Statement

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Global Health Comparison and Narrative Statement

If you talk about a possible poor health outcome, do you believe that outcome will occur? Do you believe eye contact and personal contact should be avoided?

You would have a difficult time practicing as a nurse if you believed these to be true. But they are very real beliefs in some cultures.

Differences in cultural beliefs, subcultures, religion, ethnic customs, dietary customs, language, and a host of other factors contribute to the complex environment that surrounds global healthcare issues. Failure to understand and account for these differences can create a gulf between practitioners and the public they serve.

In this Assignment, you will examine a global health issue and consider the approach to this issue by the United States and by one other country.

Global Health Comparison and Narrative Statement

To Prepare:

  • Review the World Health Organization’s (WHO) global health agenda and select one global health issue to focus on for this Assignment.
  • Select at least one additional country to compare to the U.S. for this Assignment.
  • Reflect on how the global health issue you selected is approached in the U.S. and in the additional country you selected.
  • Review and download the Global Health Comparison Matrix provided in the Resources.

The Assignment: (1- to 2-page Global Health Comparison Matrix; 1-page Plan for Social Change)

Part 1: Global Health Comparison Matrix

Focusing on the country you selected and the U.S., complete the Global Health Comparison Matrix. Be sure to address the following:

  • Consider the U.S. national/federal health policies that have been adapted for the global health issue you selected from the WHO global health agenda. Compare these policies to the additional country you selected for study.
  • Explain the strengths and weaknesses of each policy.
  • Explain how the social determinants of health may impact the global health issue you selected. Be specific and provide examples.
  • Using the WHO’s Organization’s global health agenda as well as the results of your own research, analyze how each country’s government addresses cost, quality, and access to the global health issue selected.
  • Explain how the health policy you selected might impact the health of the global population. Be specific and provide examples.
  • Explain how the health policy you selected might impact the role of the nurse in each country.
  • Explain how global health issues impact local healthcare organizations and policies in both countries. Be specific and provide examples.

Part 2: A Plan for Social Change

Reflect on the global health policy comparison and analysis you conducted in Part 1 of the Assignment and the impact that global health issues may have on the world, the U.S., your community, as well as your practice as a nurse leader.

Global Health Comparison and Narrative Statement

In a 1-page response, create a plan for social change that incorporates a global perspective or lens into your local practice and role as a nurse leader.

  • Explain how you would advocate for the incorporation of a global perspective or lens into your local practice and role as a nurse leader.
  • Explain how the incorporation of a global perspective or lens might impact your local practice and role as a nurse leader.
  • Explain how the incorporation of a global perspective or lens into your local practice as a nurse leader represents and contributes to social change. Be specific and provide examples.

 

SAMPLE ANSWER

Global Health Comparison and Narrative Statement

 

Global Healthcare Issue  

Air Pollution and climate change
Description  

According to the World Health Organization (2019), nine out of ten people breathe polluted air every day. Air pollution is considered as one of the greatest risks to global health. Air pollutants penetrate respiratory systems and circulatory systems resulting in damages to the lungs, heart and the brain. As a result, over 7 million people die yearly from heart and lung diseases. Burning of fossil fuels also contributes to climate change. Statistics shows that between 2030 and 2050, over 250,000 people will die from Malaria, heat stress and diarrhea.

 
Country United States

 

 China
Describe the policy in each country related to the identified healthcare issue -Clean Air Act

-2016 standards for heavy-duty trucks

-Diesel Emissions Reduction Act (DERA)

-California Sustainable Freight Action Plan

 

 

 

 -China has introduced a low-carbon program

-top-10,000 energy consuming enterprises program.

-the 2017 national carbon emission trading system (ETS)
What are the strengths of this policy? -The California Sustainable Freight Action Plan sets requirements to use zero to near-zero emissions equipment when transporting freight (“Policies to Reduce Pollution and Protect Health”, 2019)

-The Diesel Emissions Reduction Act encourages business owners to replace their diesel equipment at an earlier time than is legally required. Since its inception, the act has resulted in over 1700 fewer premature deaths and has over 12.6 billion USD health benefits

-2016 standards for heavy-duty trucks reduces pollutants and promotes health

-Clean Air Act requires all cars and vehicles operating in the U.S. to reduce emissions.

 

 -The low carbon program reduces coal consumption and carbon dioxide emissions. The country has constructed coal plants that utilize ultra-supercritical thermal power technology to reduce pollution

-The top 10,000 energy consuming enterprises program saves industrial energy (Tan & Lee, 2017)
What are the weaknesses of this policy? -The California Sustainable Freight Action plan lacks support from the trucking industry, uses expensive technologies.

-The Diesel Emissions Reduction Act lacks support from all the states.

-The Clean Air Act fails to provide specific guidelines to reduce fossil fuel emissions

 

 

 

 -One of the main weaknesses of ETS is that it lacks data which is required for cap settings and allowance allocation (Qi & Cheng, 2017). It is also large scale and highly complex

-China’s top 10000 energy consuming enterprise program fails to accommodate the transition of energy consumption from production to consumption sectors. The program is also very costly (Wang, Yang & Zhang, 2015)
Explain how the social determinants of health may impact the specified global health issue. (Be specific and provide examples)

 

 -African Americans have lower income, little to no education and poorer health status. These inequalities result in greater vulnerability to climate impacts. African Americans are more likely to live in neighborhoods with fewer trees.

-Native Americans and Alaska Natives subsistence hunting and fishing is at risk due to air pollution and climate change (American Public Health Association).

 

 -Reduction in poverty rates and urbanization in China has resulted in increased rates of climate-related health risks. People living in cities are more prone to respiratory infections due to high rates of pollution (Chan et al. 2019).
How has each country’ government addressed cost, quality, and access to the selected global health issue? -The US Environmental Protection Agency (EPA) conducts research on a wide range of issues associated with climate change

-National Institute of Health (NIH) is the biomedical research arm of the Department of Health and Human Services. The National Institute of Environmental Health Services (NIEHS) carries out climate change related research.

-The Centers for Disease Control and Prevention works to reduce climate change through its Climate-Ready States and Cities Initiative

-The US Global Change Research Program works under the federal research on climate change and how it affects the society.

 

 -13th five-year plan period promotes green energy, environmental management and emissions control and environmental protection

-The government introduced the Environmental Protection Tax Law in 2018
How has the identified health policy impacted the health of the global population? (Be specific and provide examples) -The Clean Air Act has resulted in a decrease in air pollution, decrease in environmental lead contamination and decreases in tropospheric ozone (Sullivan et al. 2018). The act has reduced pollution and drastically improved the health of surrounding countries.

 

 

 

 -China’s Emissions Trading Scheme has reduced the carbon emission intensity of cities in Japan which in turn has significant impacts on global warming and climate change (Zhang et al. 2019)
Describe the potential impact of the identified health policy on the role of nurse in each country. -After the implementation of the Clean Air Act, nurses in America are factoring in environmental determinants of health and health hazards during their assessments of patients.

 

 

 

 

 

 

 

 

 

 -Nurses play a critical role in reducing the health consequences of climate change and pollution. The ETS in China expects nurses to be trusted messengers of health information and serves as essential personnel in the case of disaster response
Explain how global health issues impact local healthcare organizations and policies in both countries. (Be specific and provide examples) -Many U.S. government agencies have recognized the need to improve global health. As such, they have provided funding, human resource and technical support to improve global health. Some of the initiatives include; President’s Emergency Plan for AIDS Relief (PEPAR)

 

 

 

 

 -After the SARS outbreak, China designed the world’s largest reporting system of infectious disease epidemics and public health emergencies. All local healthcare institutions report infectious disease cases to the national level
General Notes/Comments Climate change impacts human health. While negative impacts have been highlighted, there are several benefits that climate change has on public health. Milder winters would reduce the number of winter related deaths. Additionally, increases in temperature might reduce the viability of mosquito populations that transmit diseases (WHO, 2003)

 

 

  

China and the U.S together emit more than 40% of the world’s CO2.

 

A Plan for Social Change

To advocate for the incorporation of a global perspective into my role as a nurse leader, I will work closely with the International Council of Nurses (ICN) whose global vision is to lead societies to acquire better health. Among the key activities carried out by the ICN includes developing strong leadership and advocating for health-related policies. Additionally, as a global nurse, I will be culturally sensitive. In this role, I will actively carry out research on global health issues and collaborate with other care givers to find local solutions to identified issues.

Global Health Comparison and Narrative Statement

Global health issues require the cooperation of the global community to respond, plan and prepare for health equity issues among nations. As a public health nurse, my role is to eliminate health inequalities to achieve equity. Additionally, as a public health nurse I must recognize and understand the impact of social determinants of health on the population. Social determinants of health contribute to global health issues and adversely affect patient’s health outcomes. To further advocate for global health issues, I must advocate for justice and equality for individuals and the community.

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Nurses can contribute to wider spheres of influence by applying their skills to address wider issues affecting the community’s health. As a nurse advocate, my role is to be effective in advocating for change for individuals and communities. Advocacy can be achieved through the use of strategies and methods that result in change. In line with this objective, I will identify causes, issues and areas of need that matter to individuals or the community and through advocacy create awareness and advance change. I am passionate about palliative care; therefore, I will advocate    for all patients with life-limiting illnesses to receive health care that promotes their quality of life.

 

References

American Public Health Association. (n.d). Introduction to Climate Change, Health, and Equity. Retrieved from APHA_Climate-Equity_Introduction.pdf

Chan, E.Y., Ho, J., Hung, H.H., Liu, S. & Lam, H.C. (2019). Health Impact of Climate Change in Cities of Middle-Income Countries: The Case of China. British Medical Bulletin, 130(1), 5-24. Doi: 10.1093/bmb/ldz011

“Policies to Reduce Pollution and Protect Health”. (2019). Environmental Defense Fund (EDF). Retrieved from https://www.edf.org/airqualitymaps/oakland/policies-reduce-pollution-and-protect-health

Sullivan, T. et al. (2018). Air Pollution Success Stories in the United States: The Value of Long-term Observations. Environmental Science & Policy, 84(1), 69-73. https://doi.org/10.1016/j.envsci.2018.02.016

“Ten Threats to Global Health in 2019”. (2019). World Health Organization. Retrieved from www.who.int/emergencies/ten-threats-to-global-health-in-2019

Tan, X. & Lee, H. (2017). Comparative Assessment of China and U.S. Policies to Meet Climate Change Targets. Environment and Natural Resources Program, Belfer Center. Retrieved from https://www.belfercenter.org/publication/comparative-assessment-china-and-us-policies-meet-climate-change-targets

Qi, S. & Cheng. S. (2017). China’s National Emissions Trading Scheme: Integrating Cap, Coverage and Allocation. Climate Policy, 18(1), 45-59. Doi: 10.1080/14693062.2017.1415198

Wang, C., Yang, Y. & Zhang, J. (2015). China’s Sectoral Strategies in Energy Conservation and Carbon Mitigation. Climate Policy, 15(1), 60-80. Doi: 10.1080/14693062.2015.1050346

World Health Organization. (2003). Climate Change and Human Health-Risks and Responses. Summary. Retrieved from https://www.who.int/globalchange/summary/en/

Zhang, K., Xu, D., Li, S., Zhou, N. & Xiong, J. (2019). Has China’s Pilot Emissions Trading Scheme Influenced the Carbon Intensity of Output? International Journal of Environmental Research and Public Health, 16(10), 1854. Doi: 10.3390/ijerph16101854

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Evidence Based Practice in Primary Care

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Evidence Based Practice in Primary Care

Include an exemplar of a scholarly paper (3 to 5 pages in APA format) on the relevance of evidence based practice in primary care

 

56 y/o Caucasian male presents to the primary care clinic with complains of dizziness and nausea x 4 days. The patient reports he has not been able to get out of bed since the symptoms started. The patient reports symptoms are worse when he tries to get out of bed to stand. He denies any headaches or blurry vision. He states he is urinating more over the last few days and he has noticed increase in thirst. He reports he just drank a large sweet tea before he came into the clinic.

The patient reports that he is out of his Lantus and metformin because he cannot afford the refill until he gets his disability check. He is disabled after his second CVA that left his with generalized weakness. His medical history includes DM, HTN, CAD.

 

Upon arrival at the clinic, the patient’s vital signs are as follows- Blood sugar 405, B/P 190/101, HR 102, R-20, T- 98.5.

 

Using Evidence Based practice, answer the following questions thoroughly. Be sure to use APA formatting.

 

What is the pertinent positive and negative findings in this patient assessment? Create a list of differentials with rationales for this patient? Discuss a medication regimen for this patient considering his financial status? What is the priority concern for this patient? How does this patient’s comorbid diagnosis impact his current symptoms? Discuss how the patient’s’ health beliefs, culture and behaviors impact the potential outcomes for the patient.

 

SAMPLE ANSWER

Evidence Based Practice in Primary Care

Pertinent Positive and Negative Findings in Patient Assessment

Results from the patient assessment indicate that there are both pertinent positive and negative findings. Pertinent positives, in this case, include complaints of dizziness and nausea, which he has been experiencing for four days. Further, from the patient’s reports, his symptoms are worsened by standing, and as such, he is not able to get out of bed. Other complaints aired by the patient include increased urination and thirst during the preceding days. Apart from the reports provided, tests conducted upon arrival in the health facility and his medical history indicate that he has signs of hypertension, diabetes mellitus, and coronary artery disease.

Another important positive finding that may aid in explaining the recent deterioration in the patient’s health is the report on his inability to refill his medication as required to manage his chronic condition. Besides the pertinent positives, some of the negatives declined include headache and blurry vision. Examination of the patient’s vital signs also yielded important positives that shed light on the patient’s condition, including a high blood glucose level, increased blood pressure, particularly a very elevated systolic blood pressure and widened pulse pressure, and an elevated heart rate.

Differential Diagnoses for the Chronic Condition

Meniere’s disease and peripheral causes of vertigo; one of the reasonable differential diagnoses to explain the acute onset of dizziness and nausea in the patient, are the peripheral causes of vertigo since they also show an acute onset. Among the different causes of peripheral vertigo, Meniere’s disease can be identified as the most plausible differential diagnosis that should be considered in this case. According to (Kerner & Brückel (2014), the condition mostly affects individuals who are more than 50 years old and presents with a triad of intermittent vertigo, ringing in the ears and progressive deafness. Other likely differentials include inflammation of the inner ear, including labyrinthitis and vestibular neuronitis, both of which will produce persistent vertigo of acute onset, though only the former is associated with concurrent hearing loss (Muncie, Sirmans & James, 2017). These conditions are more likely to have arisen in the patient complained of a recent viral illness (Kerner & Brückel, 2014). However, none of these symptoms explain the increase in thirst and urine output.

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Vertebrobasilar ischemia (Cerebrovascular disease); from the patient’s reports, major complaints include dizziness and nausea, which increase when he stands. According to Muncie, Sirmans, and James (2017), such symptoms are consistent with vertigo, a condition that occurs once the vestibular system is affected. In this case, various diseases may affect the vestibular system’s peripheral or central parts and hence lead to vertigo (Reusch & Manson, 2018). For the patient under examination, the rapid development of signs and symptoms seem to suggest a condition that is originating from vascular. A cerebrovascular disease affecting the vertebrobasilar part of the circulation, which supplies the posterior aspects of the brain, may present with acute vertigo, thereby explaining the symptoms in this patient (Muncie, Sirmans & James, 2017).

Intracranial tumor; is another condition that can be related to the symptoms of dizziness and nausea that the patient is experiencing. The existence of a tumor would compress the vestibular centers in the brain or the nerves connecting it to the peripheral part in the inner ear, hence resulting in dizziness or nausea, as in the patient’s case. Further, for other symptoms like the frequent need to urinate and to be thirsty may be a result of a tumor compressing the pituitary gland hence preventing the release of antidiuretic hormone (Muncie, Sirmans & James, 2017).

The Patient’s Medication Regimen and Priority Concerns

From the symptoms, patient reports, and family history, the patient is likely to have been diagnosed with type 2 diabetes. The condition was previously known as a non-insulin dependent diabetes that affects sugar metabolism in the body (Kerner & Brückel, 2014). The medication regimen, in this case, would consist of low-dose sulfonylurea and metformin to reduce the high concentration of blood sugar levels. Further, to control sugar levels, other options will involve administering thiazide diuretic like hydrochlorothiazide and calcium channel blockers like nifedipine (Muncie, Sirmans & James, 2017). However, taking into consideration the financial position of the patient, he can also access generic forms of drugs to reduce the potential cost.

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The major priority concerns for the patient in question is controlling blood sugar levels as well as reducing high blood pressure. In this case, other conditions like a causative stroke would not be considered due to delayed presentation. But, by maintaining low levels of sugar and pressure levels, the risk factors for the development of subsequently severe stroke is equally reduced (Kerner & Brückel, 2014).

The Relationship between Comorbid Diagnosis with Current Symptoms.

The patient’s diagnosis is based on the fact that his comorbid diagnoses are major risk factors for cerebrovascular disease. The first aspect to consider is his medical history, which indicates that he has a history of hypertension; further, from the medical evaluation and patient reports, the high blood pressure is an indication of poorly managed hypertension. As Kerner and Brückel (2014) note, one of the major long-term complications of diabetes is the high risk of vascular diseases associated with atherosclerosis, including cerebrovascular conditions and myocardial infarction. Further, the said patient’s age is a serious factor that increases their risk for cardiovascular condition. From the patient’s history, he has previous sessions of stroke, which have left him disabled and with generalized weakness. Further, it is clear the blood sugar management is done poorly since he is unable to get the required medication. The patient reports that he is out of his Lantus and metformin because he cannot afford the refill until he gets his disability check. Clearly, this patient has a very high risk of having another cerebrovascular accident. The patient’s increased thirst and increase in urine output are an indicator of the poorly controlled blood sugars as these are some of the primary symptoms of diabetes (Reusch & Manson, 2018).

Evidence Based Practice in Primary Care

Effects of Patient’s Health Beliefs, Culture, and Behavior on Potential Outcomes

The patient’s health beliefs, culture, and behavior are undeniably crucial determinants of the outcomes of illness and treatment (Reusch & Manson, 2018). Since he suffers from a chronic condition, it is important that patient understands the nature of their illness and the need to remain compliant to medication as instructed by medical professionals as well as the recommended lifestyle changes to improve the outcomes of treatment. Conversely, the patient’s condition is likely to deteriorate further if he is negligent towards the treatment guidelines.

 

References

Kerner, W., & Brückel, J. (2014). Definition, classification, and diagnosis of diabetes mellitus.

Experimental and Clinical Endocrinology & Diabetes, 122(07), 384-386.

Muncie, H. L., Sirmans, S. M., & James, E. (2017). Dizziness: Approach to evaluation and

management. American Family Physician, 95(3), 154-162.

Reusch, J. E., & Manson, J. E. (2018). Management of type 2 diabetes in 2017. JAMA, 317(10),

1015-1016. Doi:10.1001/jama.2017.0241

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Group Therapy Progress Documentation and Analysis

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Group Therapy Progress Documentation and Analysis

Students will:

  • Develop effective documentation skills for group therapy sessions *
  • Develop diagnoses for clients receiving group psychotherapy *
  • Evaluate the efficacy of cognitive behavioral therapy for groups *
  • Analyze legal and ethical implications of counseling clients with psychiatric disorders *

Select two clients you observed or counseled this week during a group therapy session. Note: The two clients you select must have attended the same group session (group therapy session about drug addiction)

Then, in your Practicum Journal, address the following:

  • Using the Group Therapy Progress Note (see file downloaded) document the group session.
  • Describe each client (without violating HIPAA regulations), and identify any pertinent history or medical information, including prescribed medications.
  • Using the DSM-5, explain and justify your diagnosis for each client.
  • Explain whether cognitive behavioral therapy would be effective with this group. Include expected outcomes based on this therapeutic approach.
  • Explain any legal and/or ethical implications related to counseling each client.
  • Support your approach with evidence-based literature.

 

SAMPLE ANSWER

Group Therapy Progress Note American Psychological Association

Client: Mr. JJ and Mr. Q                                                   Date: 21/10/19

Group name:  Achievers                                         Minutes: 45

Group session: 1                                                Meeting attended for this client: 1

Number present in group 2 of 2      scheduled Start time: 10:00 AM           End time: 10:45

Assessment of client

  1. Participation level: ❑ Active/eager ❑ Variable ❑ only responsive ❑ Minimal ❑ Withdrawn
  2. Participation quality: ❑ Expected ❑ Supportive ❑ sharing ❑ Attentive ❑ Intrusive ❑ monopolizing ❑ Resistant ❑ other: _____________________________________
  3. Mood: ❑ Normal ❑ Anxious ❑ Depressed ❑ Angry ❑ Euphoric ❑ Other: _______________
  4. Affect: ❑ Normal ❑ Intense ❑ Blunted ❑ Inappropriate ❑ Labile ❑ Other: _______________
  5. Mental status: ❑ Normal ❑ Lack awareness ❑ Memory problems ❑ disoriented ❑ confused ❑ disorganized ❑ Vigilant ❑ Delusions ❑ Hallucinations ❑ Other: __________________
  6. Suicide/violence risk: ❑ Almost none ❑ Ideation ❑ Threat ❑ Rehearsal ❑ Gesture ❑ Attempt
  7. Change in stressors: ❑ less severe/fewer ❑ Different stressors ❑ More/more severe ❑ Chronic
  8. Change in coping ability/skills: ❑ No change ❑ Improved ❑ Less able ❑ Much less able
  9. Change in symptoms: ❑ same ❑ Less severe ❑ Resolved ❑ More severe ❑ Much worse
  10. Other observations/evaluations: patients are willing to make a change in their lives.

Group Psychotherapy is concerned with various strategies that are used in helping individuals have a safe and trustworthy forum where they would interact with each other and help each other. The group session as made up of people who were battling addiction with a majority of them having an alcohol addiction.

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Description of the Clients

One of the group members was known as Mr. JJ, a 34-year-old man who experiences insomnia. History reveals that he is very worried that he may end up losing his job and he is also unable to control the worry. The worry makes him experience challenges sleeping and therefore he would take alcohol so that he can sleep. He, therefore, began by consuming alcohol as a self-cure for insomnia but he became dependent.

The second client is Mr. Q and he is a 36-year old man who has been experiencing challenges in his marriage for a long time. He describes his wife as nagging and always complaining about the things that he cannot do for her. This makes him prefer to drown his sorrows in alcohol so that he can forget about the treatment at home. He does not want to divorce his wife because his parents had a divorce and it negatively affected him.

Diagnosis

Mr. JJ needs a dual diagnosis because he presents mental issues, i.e. depression and anxiety, in addition to alcohol use and therefore has a co-occurring disorder. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), (2013), the diagnostic criterion for insomnia is where there are complains that the patient is not satisfied with the quantity of sleep that they get or the quality. At the same time, Khurshid (2018) establishes that depression can present as insomnia and hence Mr. JJ was screened for depression. People with mental issues tend to take alcohol because of its stimulating effect so that it can help them sleep (Jacobson and Newman, 2014). Mr. Q is diagnosed with post-traumatic stress disorder because of the stress that he receives at home which makes him want to be away. According to the diagnostic and statistical manual of mental disorders, (2013), post-traumatic stress disorder is said to be present when the patient has experienced an actual exposure to a stressful event. In his case, the trauma is from the divorce that the parents had.

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In-session procedures:

For this people Cognitive-behavioral therapy (CBT) will be employed and it involves activities that will aim at exploring the negative thoughts that an individual has and replaces them with thoughts that are positive and that will play a role in creating favorable behaviors and emotions ( Patterson, 2014). Cognitive-behavioral therapy would be effective for the treatment of addiction because it is instrumental in helping them to find the relationship between their actions, thoughts and feelings and how they impact recovery. This is because CBT is based on the idea that the feelings, as well as the behaviors of an individual, are caused by their thoughts. Therefore, while they may not be able to change their circumstances they should be able to change their thoughts about them. The expected outcome is that there will be skills learned on how to cope with the issues that they go through. They will, therefore, not need to use alcohol as a coping mechanism.

Homework:

  1. To talk with the spouses about the issues that they think they can change
  2. Be more open and spend time at home
  3. Appreciate the spouses more and try to make time to do the things they all used to love

Group Therapy Progress Documentation and Analysis

Other comments:

Legal and ethical issues have been considered.

An ethical requirement for both clients is to ensure that they sign an informed consent form. This means that they will have made an informed decision to be part of the psychotherapy group. It also confirms that their participation is voluntary and rational. This is also important because it helps them to have an increased sense of ownership over the process.

The ethical issue will involve giving both of them a safe and confidential opportunity to express his concerns, fears, and issues. Privacy and confidentiality will be ensured as this is an ethical requirement for psychotherapists. As a result, everything that is discussed will be kept secret and will not be disseminated to any other person

 

Signatures     …………………………                              Date………/………../……….

 

Group Therapy Progress Documentation and Analysis

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental

Disorders, DSM-5. (5th edition). Washington, DC American Psychiatric Association.    ISBN-13: 978-8123923796

Jacobson, N. C., & Newman, M. G. (2014). Avoidance mediates the relationship between

Anxiety and depression over a decade later. Journal of anxiety disorders, 28(5), 437-445. doi: 10.1016/j.janxdis.2014.03.007

Khurshid K. A. (2018). Comorbid Insomnia and Psychiatric Disorders: An Update. Innovations

in clinical neuroscience, 15(3-4), 28–32.

Levi, O., Bar‐Haim, Y., Kreiss, Y., & Fruchter, E. (2016). Cognitive–behavioural therapy and

psychodynamic psychotherapy in the treatment of combat‐related post‐traumatic stress disorder: A comparative effectiveness study. Clinical psychology & psychotherapy, 23(4), 298-307. doi.org/10.1002/cpp.1969

 

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Social Structure and Social Interaction

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Social Structure and Social Interaction

You’ve learned how important groups, roles, statuses, and social networks are in the structure of society. In this assignment, you will complete a short answer activity in which you’ll demonstrate what you’ve learned by identifying and describing examples from your own life. Use the Assignment 2 template to complete this assignment

YOUR STATUS SET, ROLES, AND ROLE PROBLEMS 1) Status Set:

a) List five statuses that you currently have.
• Remember: A status is simply a position you fill in society. It may be a job title, but it could also include a position you fill within a family or a community. For more information, review Section 4.3 in your webtext. b) Label each status as either ascribed, achieved, or master.
• Remember: An ascribed status is one you’re born with and have no control over. An achieved status is reached through your own efforts or simply good or bad luck. A master status is so important that it overrides your other statuses. For more information, review Section 4.3 in your webtext.
2
2) Roles:

a) Choose one status from your list.

b) Describe the role that is associated with the status.
c) Describe how you learned that role.

• Remember: A role is the behavior expected of someone with a certain status. For more information, review Section 4.4 in your webtext.
3) Role Conflict:

a) Describe a time when you experienced a conflict because of the demands of two different roles associated with any of your statuses.
b) How did you resolve the conflict? (Discuss any conversation or social interactions you had.)
c) List any active listening skills you used to resolve the conflict. If you didn’t use active listening skills, then list the skills you could have used to resolve the conflict. • Remember: Refer to the active listening skills checklist in page 2.10 in your webtext.

FORMATTING 4) Your assignment must follow these formatting requirements:

• Use the Assignment 2 template to complete this assignment.

 

SAMPLE ANSWER

Social Structure and Social Interaction

1) Status Set
a) List five statuses that you currently have.

  1. Father
  2. Spouse
  • Home owner
  1. Youth leader
  2. Philanthropist
  3. b) Label each status as either ascribed, achieved or master.
  4. Father – achieved
  5. Spouse – achieved

iii.        Male – ascribed

  1. British – ascribed
  2. Teacher – achieved
    2) Roles
    a) Choose one status from your list.

Father
b) Describe the role that is associated with the status.

As a father, the primary role is to model the children in the right way. Through this, the children will be in a position to feel the significance of having a father in their lives. Being part and parcel of the children’s lives becomes integral. The father ensures that the child gets what he needs in life to live a comfortable life. Giving love to the child, teaching the necessary virtues, and providing the basis all make up the fatherly role.
c) Describe how you learned that role.

I learned the fatherly role primarily through observing how my father brought me up as the only son. He always ensured I lived a simple decent life, where basic provisions were met without fail. Taught me the right ways, which I now find important in my achieved status. This demonstrates the understanding that the learning observation right from the time I was young was not in vain.

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3) Role Conflict
a) Describe a time when you experienced conflict because of the demands of two different roles associated with any of your statuses.

At one time, I experienced a conflicting arising from the execution of my role, both as a father and a spouse. As a father, I am indebted to the children. However, as spouse, I am attached to my wife. Sometimes it was common to give all my attention to one role, without an idea that I was ignoring the other. For instance, I was torn between having to go out with my wife to fulfill my role as a spouse at the expense of my son who needed my attention. The conflict helped me learn the importance of each role to the relevant party. From then on, I tried to balance my life to ensure that I meet all my roles without fail.

Social Structure and Social Interaction
b) How did you resolve the conflict?

When I experienced the conflict of being both a spouse and father at the same time, I had to come up with a resolution that would not break either my wife or son. In this case, I had to talk to my wife because he understands well enough that I have an obligation to fulfill my role as a father. Thus, it was necessary to postpone the dinner arrangement with my wife to be there for my son as promised earlier. However, I had to inform my child in advance that I was not to be available at a later date to be with him as usual since I had to go out with my wife, his mother. In this way, there was an amicable resolution to the whole problem. Being at peace with both parties was necessary to depict that I have indeed executed my role as intended.

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c) List any active listening skills you used to resolve the conflict. If you didn’t use active listening skills, then list the skills you could have used to resolve the conflict.

The active listening skills that I used to resolve the conflict include demonstrating concern (Hoppe & Center for Creative Leadership, 2014). This was effective in communicating that I recognize each of them and my role in their life. I promised never to fail any of them, although meeting their needs would always have to entail patience form each of them. Equally, the use of brief verbal affirmations was critical (Jahromi, Tabatabaee, Abdar & Rajabi, 2016) in dealing with the conflicting situation. This was of essence depicting the fact that was aware of the concerns of each of them and would address them adequately.

 

References

Hoppe, M. H., & Center for Creative Leadership. (2014). Active listening: Improve your ability to listen and lead. Greensboro, N. C.: Center for Creative Leadership.

Jahromi, V. K., Tabatabaee, S. S., Abdar, Z. E., & Rajabi, M. (2016). Active listening: The key of successful communication in hospital managers. Electronic physician, 8(3), 2123.

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Role description for a graduate-level nurse

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Role description for a graduate-level nurse

Assume you are a nurse manager on a unit where a new nursing documentation system is to be implemented. You want to ensure that the system will be usable and acceptable for the nurses impacted. You realize a nurse leader must be on the implementation team.

To Prepare:

  • Review the steps of the Systems Development Life Cycle (SDLC) and reflect on the scenario presented.
  • Consider the benefits and challenges associated with involving a nurse leader on an implementation team for health information technology.

The Assignment: (2-3 pages)

In preparation of filling this role, develop a 2- to 3-page role description for a graduate-level nurse to guide his/her participation on the implementation team. The role description should be based on the SDLC stages and tasks and should clearly define how this individual will participate in and impact each of the following steps:

  • Planning and requirements definition
  • Analysis
  • Design of the new system
  • Implementation
  • Post-implementation support

 

SAMPLE ANSWER

The Role of the RN/APRN in Policy Evaluation

Two significant opportunities that RNs and APRNs nurses have to enable them to participate in policy reviews include their capacity to influence health delivery and the professional organizations that they identify with as members (Milstead & Short, 2019). As professionals, nurses contribute towards caregiving for the sick. In this way, they bring into perspective a platform that enables them to care for the patients adequately. Equally, the entry of nurses into areas such as the American Nurses Organization presents a significant opportunity for them realize crucial opportunities in their professional undertaking to enhance policy reviews.

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The opportunities that exist of the nurses may present diverse challenges such as issues pertaining to entry to the professional organizations. The professes of subscribing into those bodies may either be complex or have barriers that make entry difficult especially if the nurses fail to meet the minimum requirements (Shiramizu, Shambaugh, Petrovich, Seto, Ho, Mokuau & Hedges, 2016). Overcoming such a challenge requires the organizations to give clear guidelines on membership criteria. Equally, providing guidance during the registration process would bring many nurses on board. On the other hand, in their capacity to influence health delivery, and ultimately policy reviews, the professionals may lack adequate information to implement the necessary details. Thus, providing the relevant information and making it available for the nurses to use would prove effective in dealing with the impending challenge.

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When communicating the opportunities that are available for the professional nurses to enable them adequately participate in policy reviews, the best strategies to implement are timing and leadership (Williams & Anderson, 2018). Through proper timing, it is possible to know when and when not to facilitate those reviews. In this way, it becomes easy to avoid the negative adversities associated with writing timing. Equally, having in place astute leadership would go a long way in facilitating policy reviews. Leadership is an integral ingredient in ensuring that policy review is done accordingly.

 

References

Milstead, J. A., & Short, N. M. (2019). Health Policy and Politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.

Shiramizu, B., Shambaugh, V., Petrovich, H., Seto, T. B., Ho, T., Mokuau, N., & Hedges, J. R. (2016). Leading by success: Impact of a clinical and translational research infrastructure program to address health inequities. Journal of Racial and Ethnic Health Disparities, 4(5), 983–991. doi:10.1007/s40615-016-0302-4

Williams, J. K., & Anderson, C. M. (2018). Omics research ethics considerations. Nursing Outlook, 66(4), 386–393. doi:10.1016/j.outlook.2018.05.003

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