NURS6231 Healthcare Systems and Quality Outcomes
Week 1 Discussion
Quality Improvement
The Institute of Medicine’s six domains of healthcare quality—safe, effective, patient-centered, timely, efficient, and equitable—provide a framework for assessing quality and guiding improvement. Though broad, the domains can help in generating more specific measures to monitor within an organization.
For example, if a nurse executive were interested in the timeliness of care, he or she may want to analyze appointment wait times.
For this Discussion, you consider your own experiences in healthcare settings—either professional or personal—and evaluate one situation for its markers of quality.
To Prepare:
Reflect on your familiarity with quality improvement.
Think of a time you experienced high- or low-quality healthcare, either as a professional or as a patient or family member.
By Day 3 of Week 1
Post a reflection on your personal and/or professional experiences with quality improvement. First, assess your familiarity with quality improvement in healthcare. Then, describe a time you experienced healthcare that was representative of either high or low quality. Be specific and provide examples. Explain which domains of healthcare quality were present and absent in that scenario.
Note:?For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the "Post to Discussion Question" link and then select "Create Thread" to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on?Submit!
Read a selection of your colleagues’ responses.
By Day 6 of Week 1
Respond to at least two of your colleagues on two different days by comparing your experiences with quality improvement to theirs. Explain how your colleague’s post has changed or broadened your perspective. What surprises you about your colleague’s experience?
NURS6231 Healthcare Systems and Quality Outcomes
Week 2 Discussion
Quality Improvement Tools
Have you ever used a pro and con list to work through a challenging decision? Have you checked items or steps off a notepad as you completed them? The seven tools of quality—and their many derivatives—assist healthcare professionals in a similar way, by breaking down complex processes so that they can be more easily understood. These instruments also assist in analyzing data so that quality improvement decisions can be made.
For this Discussion, you will reflect on the quality improvement tools you have used in the nursing workplace and the impact they have had.
To Prepare:
Review the quality tools described in Chapter 4 of the Johnson and Sollecito text; the Neuhauser, Myhre, and Alemi workbook; and the American Society for Quality website.
Consider a situation when you used a quality tool in a healthcare setting.
By Day 3 of Week 2
Post a description of the quality improvement tools you have used or have been introduced to in healthcare. Provide an example of how you have used a quality improvement tool in the past and the effect it had on you, the organization, and/or patients. Be specific and provide examples.
Note:?For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the "Post to Discussion Question" link and then select "Create Thread" to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on?Submit!
Read a selection of your colleagues’ responses.
By Day 6 of Week 2
Respond to at least two of your colleagues on two different days by sharing the challenges or successes you have experienced using quality improvement tools. Additionally, suggest tips or recommendations to colleagues who may not be familiar with a certain tool that you are.
NURS6231 Healthcare Systems and Quality Outcomes
Week 3 Discussion
Personal Improvement Project Status
At the start of a new year, gyms are flooded with people who have made a resolution to be healthier. By March, the flood has dwindled to a stream. Though people may have the best of intentions, sometimes their goals do not come to fruition. How are you monitoring progress toward your personal improvement goal?
A benefit of this course is that you have a place to test out tools, methods, and processes that may be beneficial to you as a nurse executive engaged in CQI. You can take a risk, you can experience challenges or even fail, and you can learn from those challenges, within the confines of the classroom. Your colleagues are doing the same.
For this Discussion, you will evaluate progress on your Personal Improvement Project, taking a hard look at the measures you have chosen to track and whether the data are aligning with your intended goal. You will also share insights, methods, and tools with your colleagues in order to support one another.
To Prepare:
Reflect on the steps you have taken in your Personal Improvement Project.
Access and examine the data you have gathered.
Evaluate the tools available to you and how you plan to use them.
By Day 3 of Week 3
Post an assessment of your progress with your Personal Improvement Project.
Challenges and Successes: What have you found challenging about the Personal Improvement Project and what have you found easier than expected? How so?
Alignment of Measures: Consider whether the data you have collected thus far is giving you the data you need to meet your goal. Why or why not? If not, then adjust your approach accordingly.
Tools: What tools have you found useful or not useful? What diagrams are you planning to use? How are you going about developing your process map?
Note:?For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the "Post to Discussion Question" link and then select "Create Thread" to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on?Submit!
Read a selection of your colleagues’ responses.
By Day 6 of Week 3
Respond to at least two of your colleagues on two different days by sharing tips, resources, or experiences in support of their progress.
NURS6231 Healthcare Systems and Quality Outcomes
Week 5 Discussion
Case Study Analysis
Nurse executives may be tasked with evaluating adverse safety events—either individually or as part of an interdisciplinary team—to prevent them in the future. An evaluation may consist of analyzing every step in the patient’s care process to see what did and did not occur. Tools like the process map allow this kind of step-by-step view.
For this Discussion, you will read about two real cases that resulted in negative outcomes and—much like a root cause analyst—examine what went wrong from a quality and safety standpoint.
To Prepare:
Read about both the Lewis Blackman and Noah Lord cases in the Learning Resources. Select one on which to write your initial post.
By Day 3 of Week 5
Post a response that addresses the following questions for the case you have chosen:
In what way did the system fail the patient and his family?
What communication problems are apparent in the case?
Where in the process of care did incidents (errors, near misses, adverse events, and harm) occur?
Note:?For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the "Post to Discussion Question" link and then select "Create Thread" to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on?Submit!
Read a selection of your colleagues’ responses.
By Day 6 of Week 5
Respond to at least two of your colleagues on two different days, ensuring that you respond to at least one Lewis Blackman and at least one Noah Lord case analysis.
Respectfully agree or disagree with your colleague’s analysis of the case. Additionally, make a recommendation for quality improvement and explain how it would address the identified problems
NURS6231 Healthcare Systems and Quality Outcomes
Week 7 Discussion
Quality Measures
Photo Credit: Getty Images
If you were to set out with the goal of measuring overall quality and safety in a given healthcare organization, where would you begin? Any number of measures contribute to the picture. According to the Donabedian model, quality measures fall into three groups: those that deal with the structure (i.e., the setting in which care is provided), the process (i.e., how the care is provided), and the outcome (i.e., what resulted from care). To get a complete picture of quality, all three types of measures should be included.
For this Discussion, you will practice selecting quality measures. You will then use those measures in next week’s Module 2 Assignment as you build a quality dashboard.
To Prepare:
Review the Community General Hospital Case Study presented in the Learning Resources.
Research quality and safety measures using the links provided in the Case Study document and in the Learning Resources.
Consider the priority areas for measurement for Community General Hospital.
By Day 3 of Week 7
Based on the case study, identify 6–8 measures for inclusion in a dashboard for the Community General Hospital Board. What organizational, national, and regulatory factors contributed to your decision to focus on these areas? Describe what you would expect to learn from measurement and evaluation of your identified priority areas. Be specific and provide examples.
Note:?For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the "Post to Discussion Question" link and then select "Create Thread" to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on?Submit!
NURS6231 Healthcare Systems and Quality Outcomes
Week 9 Discussion
Interdisciplinary Approach
By nature, healthcare requires an interdisciplinary approach. Patients may have “one doctor” at their primary care practice, for example, but they also engage with the complete team, including nurses, administrative support personnel, and lab technicians. Perhaps a specialist is called in to assist with a particular condition. All along the way, communication must remain open, direct, and frequent to best support the patient in a seamless and personalized experience. The effectiveness of interdisciplinary teams directly correlates to quality and patient satisfaction. If communication or collaboration falter, quality can suffer.
For this Discussion, you will read scenarios where quality has potentially been compromised. Using what you have learned about interdisciplinary collaboration, you will develop a solution to the problem.
To Prepare:
Review the Interdisciplinary Collaboration Scenarios below and choose one to focus on for your initial post.
Scenario A:
At Meridien Medical Center, hospital policy is to document the “reason” for not administering a medication that is ordered but not administered. The documented reason of “patient refusal” for venous thromboembolism (VTE) prophylaxis has been high across hospital units. In order to improve patient outcomes, the Quality and Patient Safety Committee decided to explore why so many patients refuse VTE prophylaxis. Their inquiry revealed that less experienced nurses were not very comfortable teaching patients about the risks of VTE and pulmonary embolism if they declined the shot. Using an interdisciplinary and collaborative approach, how would you plan to address the situation?
Scenario B:
A new social work graduate, Monica, just started on your unit at Meridien Medical Center, 14 South. She is young and energetic, and everyone seems to like her. The other day during interdisciplinary rounds she was on her phone repeatedly. At first you gave her the benefit of the doubt . . . maybe she was responding to patient messages. But when the attending physician asked Monica a direct question about a patient, she looked up from her phone, mumbled an excuse, and asked the doctor to repeat his question. The physician has voiced his frustrations, citing unprofessionalism and inattentiveness as concerns. Fran, also a member of the team, is an older nurse who has had a productive career at the hospital. When talking about Monica, Fran has lately been seen rolling her eyes and making sarcastic comments about “Gen Z.” You want to help both Monica and Fran be effective team members. What do you do before this problem gets out of hand?
Scenario C:
Photo Credit: Getty Images/Caiaimage
Current practice for interdisciplinary rounds on the post-surgery cardiac unit of Meridien Medical Center is to include the surgeon, attending physician, medical student, and nurse. These team members work well together to assess cases and coordinate care. But you know that the unit has had some adverse drug events lately, particularly in the older patient population. What additional roles/team members would you advocate adding, and how would you get buy-in from existing team members?
Scenario D:
Nurses on the obstetrics ward at Meridien Medical Center typically conduct an independent assessment of the patient and then report that assessment during an interdisciplinary team meeting. All members of the team have agreed that these meetings are important for continuity of care and analysis of complex cases. On this particular day, Mark, a seasoned nurse on the unit, provides information about his patients during the meeting. The physician in attendance interrupts Mark and indicates that Mark should hurry up because she needs to be elsewhere helping patients. As Mark is leaving the meeting, he hears the physician say to a colleague, “I’m just going to do my own assessment anyway.” Mark ends up feeling like his work is not appreciated and that the physician is only going to the team meetings out of contractual obligation. How do you support Mark and restore the spirit of interdisciplinary collaboration?
By Day 3 of Week 9
After reading through your chosen scenario: Post an explanation of how you would support the interdisciplinary team. Specifically, recommend and justify a strategy for addressing the central conflict or issue. Explain how a strengthened interdisciplinary approach relates to quality of care and patient outcomes in the scenario. Then explain what diversity (e.g., different generation cohorts, levels of experience, specialties, backgrounds, races, and genders) brings to the team and how you would leverage that in the scenario. Be specific and provide examples.
Note:?For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the "Post to Discussion Question" link and then select "Create Thread" to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on?Submit!
Read a selection of your colleagues’ responses.
By Day 6 of Week 9
Respond to at least two of your colleagues on two different days who chose a different scenario than you did. Build on your colleague’s discussion of interdisciplinary collaboration in the scenario. Explain how you might support the team and approach the conflict or issue differently.
NURS6231 Healthcare Systems and Quality Outcomes
Week 11 Discussion
Innovation Sharing
To engage in thought leadership and advance the profession, nurse executives who conduct research or integrate innovations often share their contributions with the wider nursing community. Methods of dissemination include writing journal articles and presenting at professional conferences such as the American Organization for Nursing Leadership annual conference. Conferences are a stimulating way to try out new ideas on an audience and engage in conversations with equally passionate leaders.
For this Discussion, you will mimic the experience of a conference by sharing your identified innovation with your colleagues and inviting dialogue.
To Prepare:
Reflect on the development of your PowerPoint presentation.
Review the Learning Resources on implementing innovations and consider potential challenges to implementation.
By Day 3 of Week 11
Post your narrated PowerPoint to share with the rest of your class. Then, in your post, include a reflection of insights you have gained by analyzing the innovation and creating the presentation. If you were to implement the innovation in a current or future workplace, what challenges might there be? Explain two challenges you anticipate related to staff, leadership, systems, processes, or technology.
Note:?For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the "Post to Discussion Question" link and then select "Create Thread" to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on?Submit!
View a selection of your colleagues’ videos and read their reflections.
By Day 6 of Week 11
Respond to at least two of your colleagues on two different days by evaluating their innovations, including the strengths, limitations, and one way to address a challenge to implementation they have identified. Also explain how you could use the innovation in your own current or future professional practice to improve quality outcomes.
