Nurs-6231 Healthcare Systems and Quality Outcomes

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NURS 6231 Healthcare Systems and Quality Outcomes Course Project: Promoting Health Care Quality

Overview

In this course, you develop a comprehensive Course Project: Promoting Health Care Quality. To initiate this project, this week you examine the systems and structures of an organization with which you are familiar.

Week 3: Organizational Systems and Structures, Part 1

Section 1: Organizational Systems and Structures Evaluation When a problem related to health care quality and patient safety arises, there can be an inclination to focus on a specific event rather than to examine the larger context surrounding it. Analyzing the systems and structures within an organization provides a foundation for generating a fuller understanding of how and why the event occurred and for developing strategies to address the underlying issues. Perhaps more importantly, such an analysis can be used to proactively identify potential challenges and improve organizational systems and structures in order to promote positive outcomes. In the first section of your Course Project, you analyze the systems and structures of a health care organization with which you are familiar. To prepare:

 Identify a health care organization with which you are familiar; one that you will be able to sufficiently analyze to complete the full scope of the Course Project. (Refer to the Course Project Overview as needed.) This may be the same organization that you addressed in this week’s Discussion.

 Select two or more of the following frameworks: o Learning organizations o Complex adaptive systems (CAS) o Clinical microsystems o Good to great o The 5 Ps

You may use the same frameworks that you addressed in this week’s Discussion.

 With these frameworks in mind, analyze the systems and structures of the organization. Be sure to research and consider: o Mission, vision, and values o Strategic plan, goals, and objectives, if possible o Key operational processes and patterns o Information technology use o Organizational priorities and investments, as indicated by financial data

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In Week 4, you will receive instructions for integrating an analysis of organizational culture into development of Section 1 of your Course Project. Once you have completed your evaluation, you will write a 3- to 5-page paper, which is due by Day 7 of Week 4.

Week 4: Organizational Systems and Structures, Part 2 Section 1: Organizational Systems and Structures Evaluation

As you continue your evaluation of a health care organization, it is essential to pay attention to culture. Organizational culture provides the context in which all interactions and processes occur, and is therefore central to any effort to enact change. To prepare:

 Continue to analyze your selected organization, as indicated in Week 3 (Section 1 of the Course Project).

 In addition, consider the ideas and information exchanged in this week’s Discussion. Continue to analyze essential elements of organizational culture and evaluate the influence of culture on the ability to achieve goals within your selected organization.

To complete: Write a 3- to 5-page paper in which you:

 Provide a description of the organization that you selected

 Present your analysis of the organization with attention to: o Its mission, vision, values o Strategic plan, goals, and objectives o Key operational processes and patterns o Information technology use o Organizational priorities and investments, as indicated by financial data o The essential elements of the organization’s culture o The influence of culture on meeting organizational goals

Due by Day 7. Section 2: Quality Improvement Issue To help you move forward with your Course Project, this week you identify a quality issue that you would like to address and submit a description of this issue for Instructor feedback. Your proposed issue should reflect a genuine need for improvement within your selected health care organization. Through your Course Project, you will analyze this. Nurs-6231 Healthcare Systems and Quality Outcomes

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issue and propose strategies to improve outcome(s), including the redesign of a related process. To prepare:

 Review the six quality improvement aims from the Institute of Medicine (IOM) presented in Chapter 3 of the Sadeghi, Barzi, Mikhail, and Shabot text.

 Conduct a search of the literature to help you identify a specific issue that warrants attention and action to promote quality improvement.

 Consider what you have surmised thus far through your analysis of the organization that you selected. What have you noticed that could help you identify a quality- related need for improvement? For instance:

o What has captured your attention in meetings, reports, and/or daily activities? o Have you noticed discrepancies between activities in the organization and

recommendations in the research literature, quality standards, and/or the organization’s stated policies and procedures?

o If so, what do you think could be the reason(s) for variations or gaps between what you have observed and what is recommended?

 Identify a quality improvement issue that you would like to investigate for this project. Note: Review the Course Project Overview/full instructions, located in the Week 3 Learning Resources, as needed to identify a quality improvement issue that is viable for completing the full scope of this project. Once you receive a response from your Instructor on the quality improvement issue that you submit, be sure to integrate his or her feedback before moving forward with Section 3 of your Course Project. To complete: Write a brief description of the quality improvement issue that you would like to address for your Course Project. Submit by Day 7.

Week 6: The Quality Movement

Section 3: Quality Measurement and Assessment

Measuring and assessing quality provides a foundation for identifying needs for improvement, developing effective interventions, and then monitoring progress toward desired results.

In this section of the Course Project, you focus on what you would measure—and how you would measure it—relative to your previously identified quality improvement issue. Note: This section of the Course Project will serve as the Portfolio Assignment for this course.

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To prepare:

 Review the Learning Resources. Also conduct a search of the literature related to your selected quality improvement issue and complete the “Evidence Matrix” document (provided in this week’s Learning Resources).

 Evaluate the evidence presented in the research literature and the quality standards proposed by various organizations, including the IOM’s six aims for quality improvement.

 Based on this review and your knowledge of the organization that you have selected, determine appropriate measures and indicators of performance related to your identified quality improvement issue.

 Consider how you could gather and use historical evidence of the organization’s performance related to the quality improvement issue. Also consider methods for gathering and assessing current quantitative and qualitative data, including those currently in use by the organization (e.g., chart audit data, staff surveys, quality indicators that are monitored, observations). If possible, examine actual data to assess your selected organization’s performance related to the issue.

 Think about what, specifically, you would like to achieve related to this issue. Establish realistic, evidence-based quality performance targets.

 Analyze gap(s) between the organization’s current performance and the performance targets.

 As you do this, you may wish to create a graphic organizer / alignment chart for your own use that illustrates:

o The measures and indicators that you would evaluate o Current and historical data related to this quality issue —either actual data or

methods for how you would collect and analyze the data o Methods for collecting and analyzing data in the future (including when you

would do this) o Realistic, evidence-based targets

Additional instructions for Section 3 are presented in Week 7. To complete this Assignment, you will write a paper introducing your quality improvement plan. This Assignment is due by Day 7 of Week 8.

Week 7: Improvement Science Section 3: Quality Measurement and Assessment Continue working on Section 3, introduced in Week 6. To prepare:

 Think about the quality improvement issue that you are addressing and the associated plan you are developing. Consider the following:

o What is the overall purpose, or aim, of doing this work?

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o What would you hope to achieve for the organization by undertaking this project? What are the objectives of this initiative?

o What value would this work add to the organization? o How would this work improve practice and create outcomes with impact?

 Review Chapter 7 of the Sadeghi, Barzi, Mikhail, and Shabot course text. Consider how addressing this quality improvement issue would align with the organization’s mission, vision, values, and strategic goals and objectives. How does it relate to regulatory issues, and other matters that are significant for the organization? If you notice a misalignment, use this as an opportunity to refine your focus.

 With this in mind, continue to hone your development of this Assignment, integrating the concepts addressed here into Section 3.

To complete: Write a 3- to 5-page paper that includes:

 An introduction to your quality improvement plan, including the overarching aim of this initiative and an explanation of how it aligns with the mission, vision, values, and strategic goals and objectives of the organization, as well as regulatory issues and other matters that are significant for the organization

 An overview of the current situation with regard to this quality improvement issue in the organization

 A description of measures and indicators

 A presentation on data related to this issue, including: o Actual historical and current data and / or a description of the methods you

would use to collect and analyze the data o Methods for collecting and analyzing data in the future, including when you

would do this

 A description of realistic, evidence-based targets Be sure to cite evidence from the literature to justify your selection of the measures and indicators, as well as the performance targets. Note: This section of the Course Project serves as the Portfolio Assignment for this course. Due by Day 7 of Week 8.

Section 4: Quality Improvement Strategies Start to think about quality improvement methods/strategies (these relate to bridging the gap between current performance and targets as established in Section 3).

To prepare:

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 Refer to the modified Donabedian model (access, structure, process, outcome, and patient experience) presented in Chapter 9 of the Sadeghi, Barzi, Mikhail, and Shabot text.

 Recall the performance targets that you identified for Section 3 (in Week 6). What does the recommendation that performance-driven planning should “begin with the end in mind” suggest given your established goals?

 Review the information presented in Chapter 9 of the Sadeghi, Barzi, Mikhail, and Shabot text, and think about how you would assess the organization’s strengths and weaknesses related to the performance gaps that you identified in Section 3 (Week 6). Nurs-6231 Healthcare Systems and Quality Outcomes

 Based on the above, start to think of specific evidence-based strategies that could be implemented to close / minimize the performance gaps that you have identified. Consider both interventions (what) and processes (how). Focus on strategies that are supported by the latest research and could create systems-level change. These may be tentative for now, but be sure to identify at least one that specifically lends itself to a change in process (i.e., practice, protocol, pathway, activity).

Additional instructions for Section 4 are presented next week. To complete this Assignment, you will create a process map and write a paper describing quality improvement strategies. This Assignment is due by Day 7 of Week 8.

Week 8: Process Mapping Section 3: Quality Measurement and Assessment Review the complete Assignment description presented in Weeks 6 and 7. Submit Section 3 by Day 7.

Section 4: Quality Improvement Strategies

For this section of your Course Project, you create a process map to examine a current process related to your quality improvement issue. You will use the results of the process mapping to redesign a process to help minimize or close the performance gap(s). As you proceed, keep in mind the importance of maintaining a patient-centered focus so the patient experience is not negatively affected by any changes in process.

To prepare:

 Review the instructions provided in the Learning Resources for creating a process map.

 With your quality improvement issue in mind, as well as the other work you have completed on your Course Project thus far, think about how creating a process map could help you to better understand your quality improvement issue and redesign an associated process.

 Create a process map using Microsoft Word or PowerPoint.

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 Refine the strategies for promoting systems-level change to minimize or close the performance gap(s) that you began to think about in Week 7. As part of this, identify a way to redesign at least one process based on your analysis of the process map you have created. Nurs-6231 Healthcare Systems and Quality Outcomes

To complete:

 Write a 2- to 3-page paper in which you describe quality improvement strategies that you selected related to your quality improvement issue.

 Finalize your process map, which will be submitted along with the paper.

Submit your paper and process map by Day 7.

Week 9: Evaluating Outcomes Section 5: Evaluation Plan

To prepare:

 Review the information on evaluation, including data representation and quality monitoring, presented in the Learning Resources.

 Review your work on the Course Project thus far, particularly Sections 3 and 4.

 Think about how your quality improvement initiative could be evaluated. Consider the following: o Which stakeholders need information related to this initiative? What do they need

this information for? o How would you assess the outcomes in the short-term and long-term? o How would you analyze related processes, including but not limited to the one

you redesigned in Section 4? o How should an analysis of organizational structures be integrated into your

evaluation? o How would you identify and evaluate any unintended consequences that may

arise? o What metrics should the organization use to gauge progress and the

effectiveness of the quality improvement initiative? How would these metrics incorporate the measures and indicators you identified in Section 3? Are there additional measures and indictors that you now think should be included?

o How should the organization track and display data for an interdisciplinary audience? How could the use of a dashboard or balanced scorecard be of value?

o How could the organization create an integrated view of performance that links finance and quality?

To complete: Develop a 2- to 3-page evaluation plan that includes the following:

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 An outline of the methods that you would propose for evaluating the quality improvement initiative and the financial implications

 A description of specific metrics that integrate your previously identified measures and indicators and any others you have deemed important

 A recommendation of how the organization could represent data related to this quality improvement issue for ongoing monitoring and to determine the value or success of the initiative

 An explanation of how the organization could create an integrated view of performance that links finance and quality

This Assignment is due by Day 7 of Week 10.

Section 6: Quality Improvement Plan

In this section of the Course Project, you synthesize your analysis and recommendations into an action plan for implementing the quality improvement initiative. To prepare:

 Begin to develop a plan for implementing your quality improvement initiative, including the redesigned process that you identified in Section 3. Consider the following: o How would you undertake the process of determining a timeline for planning,

implementing, and evaluating this quality improvement plan? o What are some reasonable milestones for this initiative? What are the daily,

weekly, monthly steps/goals? To complete:

 Write a 2- to 3-page summary of your quality improvement action plan.

This Assignment is due by Day 7 of Week 10.

Week 10: Interdisciplinary Collaboration Section 5: Evaluation Plan Review the complete Assignment description presented in Week 9. Submit Section 5 by Day 7. Section 6: Quality Improvement Action Plan. Nurs-6231 Healthcare Systems and Quality Outcomes

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Review the complete Assignment description presented in Week 9. Submit Section 6 by Day 7.