NURS6231 Healthcare Systems and Quality Outcomes
Week 1 Discussion
Quality Improvement
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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.
NURS6231 Healthcare Systems and Quality Outcomes
Week 2 Discussion
Quality Improvement Tools
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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.
NURS6231 Healthcare Systems and Quality Outcomes
Week 3 Discussion
Personal Improvement Project Status
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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?
NURS6231 Healthcare Systems and Quality Outcomes
Week 5 Discussion
Case Study Analysis
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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?
NURS6231 Healthcare Systems and Quality Outcomes
Week 7 Discussion
Quality Measures
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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.
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:
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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.
NURS6231 Healthcare Systems and Quality Outcomes
Week 11 Discussion
Innovation Sharing
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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.
NURS6231 Healthcare Systems and Quality Outcomes
Week 1 Journal
Personal Improvement Project Topic
The aim of the Personal Improvement Project is to experiment with a small change that is under your personal control; collect, analyze, and interpret data; and then reflect on what you have learned from your project about the general challenge of changing something. Through this multi-week project, you will see how the quality improvement process works in general and familiarize yourself with the tools used for healthcare QI. For this Journal, you will select and describe your Personal Improvement Project topic.
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To Prepare:
Review the Neuhauser, Mhyre, and Alemi (2004) workbook in the Learning Resources. The workbook includes topic ideas, the general process to follow, and example charts.
Select an area for personal improvement. For your project, you will need to initiate a change and then collect data to see whether you have improved. Some general examples are exercise and time management. Note that in Week 3 you will share your progress on this project with colleagues in Discussion, so please choose a topic that you are comfortable sharing.
Based on the topic area, determine the aim or goal of your project. What would you like to accomplish? How will you know that you have improved?
Journal (1 page)
Describe the topic and aim of your Personal Improvement Project. Explain why this improvement area is important to you and what you expect to gain from the data you will collect.
NURS6231 Healthcare Systems and Quality Outcomes
Week 2 Journal
Personal Improvement Project Outline
Before engaging in any given project, it is helpful to have a plan. An outline allows you to map out the steps of your project and foresee any challenges you may experience along the way. It also can serve as a checkpoint. As you are collecting and analyzing your data in later weeks, you may want to return to your outline and check that you are addressing what you had intended. For this Journal, you will create an outline of your Personal Improvement Project to guide you both in carrying out the project and in synthesizing the results for your Module 1 Assignment.
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To Prepare:
Download the Project Outline Template from the Learning Resources.
Journal (1 page)
Using the Project Outline Template, develop an initial outline of your Personal Improvement Project that addresses each part of the Assignment.
NURS6231 Healthcare Systems and Quality Outcomes
Week 4 Journal
Medical Errors
Not all medical errors carry extreme consequences like those described in this week’s introduction, but they are harmful just the same. Most people have experienced some form of medical error. For example, perhaps you were prescribed a medication that interfered with another of your medications. Perhaps you received an inaccurate diagnosis that led to unnecessary testing or prolonged discomfort. For this Journal, you reflect on an experience you had with a medical error and explore tools that could have assisted in prevention.
Assignments
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Journal (1 page)
Describe a time when you experienced a medical error as a student, practicing nurse, patient, or family member. Be sure to explain the circumstances of the error, as well as the quality and safety methods and tools that could have helped prevent the error. Be specific and provide examples.
NURS6231 Healthcare Systems and Quality Outcomes
Week 6 Assignment
Personal Improvement Project Report
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For this week, you will begin work on your Module 1 Assignment, which will be due in Week 6.
Suppose you wanted to improve something about yourself and your behaviors. Let’s take the example of lowering caffeine intake. How would you begin? According to the principles of CQI, you would approach it in an analytical manner. You would examine the reasons for your caffeine use and begin to track consumption, noting the amount you take in, the times of day, and the physical and mental effects. You would then attempt to reduce the intake and continue to track all the same points. Then you would consider the data you have gathered and whether you succeeded in your aim.
For your Module 1 Assignment, you will go through these steps with a personal improvement topic of your choosing. You will then write a report summarizing the data and process you followed and applying what you’ve learned to a healthcare context.
The Assignment (4–5 pages, not counting tables, graphs, diagrams, and charts):
Part 1: Aim
Clearly state the aim of your project.
Part 2: Process Analysis
Consider the process leading to the results that you aimed to improve. Create a process map to identify the steps in the process and identify the people (other than you) who were involved in the process.
Part 3: Measurement
Describe the data collection method used, including an explanation of what you measured and how. Be specific.
Present the data in a table, graph, diagram, run chart, or XmR chart.
Part 4: Changes
There is a saying, “Not all change leads to improvement, but all improvement leads to change.” Explain the changes you made based on the data. What worked? What didn’t work?
Part 5: Reflection and Application
Reflect on your Personal Improvement Project and what you learned.
Explain how you will maintain ongoing improvement in this area long-term.
Explain how you could use knowledge from this experience to facilitate both a unit-level and an organization-level change in a nursing workplace. Be specific and provide examples.
NURS6231 Healthcare Systems and Quality Outcomes
Week 8 Assignment
Quality Dashboard
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For this week, you will begin work on your Module 2 Assignment, which will be due in Week 8.
To Prepare:
Review the Community General Hospital Case Study presented in the Learning Resources.
Complete the Week 7 Discussion in which you research quality and safety measures and select 6–8 measures for inclusion in a dashboard for the Community General Hospital Board.
Review any feedback received in Discussion about your chosen measures.
Determine how you will display the measures in your dashboard.
Assignment
Part 1: Dashboard
Using Microsoft Excel or PowerPoint, create a quality dashboard based on the Community General Hospital Case Study. Your dashboard must include 6–8 measures. Use mock data to represent the measures you have chosen.
Part 2: Written Summary
To accompany your dashboard, write a 2- to 3-page paper in which you do the following:
Identify the 6–8 quality measures you have chosen for your dashboard.
Explain why these measures are important to the organization.
Analyze how the Triple Aim/Quadruple Aim is represented in your chosen measures.
Explain how you displayed the measures. Justify your choice of display.
Provide a strategy for communicating the dashboard throughout the organization.
Explain how the dashboard could be used as a leadership tool to improve patient outcomes.
NURS6231 Healthcare Systems and Quality Outcomes
Week 10 Assignment
Innovation Presentation
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You have likely looked around your healthcare organization at some point and identified a problem. Perhaps you have said, “There must be an easier way,” or “That process just doesn’t make sense.” The issue may not have been addressed, due to time or money constraints—or due to legacy thinking about the right way to perform the function.
The good news is that healthcare develops at a rapid pace. By looking at the research landscape, nurse executives can identify tested innovations that may provide novel solutions for lingering organizational problems.
For this Assignment, you seek out innovations to address a workplace problem, and you pitch that innovation to colleagues at a staff meeting.
To Prepare:
Identify a systems or organizational performance problem in your current or previous workplace that may be helped by an innovation.
Search in the library databases for articles on healthcare innovations that may address the problem you have identified.
Select at least three research articles to use for this Assignment.
Use the PowerPoint template in the Learning Resources to complete this Assignment.
The Assignment (8- to 10-slide narrated PowerPoint presentation with speaker’s notes; no longer than 10 minutes)
Imagine that you are presenting on the identified problem at a staff meeting in your current or past workplace. For the meeting, develop an evidence-based narrated PowerPoint presentation to support application of an innovation drawing from the ones you have researched.
Your narrated presentation should be 8–10 slides long and include speaker’s notes. The narration should be no longer than 10 minutes. In your presentation, address the following:
In your presentation, address the following:
Describe the problem you have identified and why it is important to address. Be specific.
Synthesize the three research articles you read and summarize the takeaways you can apply to your proposed innovation.
Explain your proposed innovation and how it would address the systems or organizational problem you have identified. Be specific and provide examples.
Describe the potential impact of the innovation on patient experience and outcomes. Be specific.
Explain how you would apply the innovation in the workplace, based on the research.
With the exception of?a title slide and reference slide, each slide should contain?speaker’s notes and voiceover narration that reflect what you would say were you to?give a live presentation.
