[Solved] Quality and Sustainability Paper Part Two Analysis and Application (Sample Answer)

Quality and Sustainability Paper Part Two – Analysis and Application

(WEEK FOUR)

The Quality and Sustainability Paper is a practice immersion assignment designed to be completed in three sections. This is part two of the assignment. Learners are required to analyze the quality outcomes and/or patient safety measures of a health care entity to determine its successes and failures, identify potential obstacles to the implementation of the measures, and determine what collaborative efforts are needed to create sustainability.

General Guidelines:

Use the following information to ensure successful completion of the assignment:

• APA style is required for this assignment.
• This assignment requires that you support your position by referencing at least eight scholarly resources.

Directions:

Write a paper (1,250-1,500 words) that provides the following:

1. Identify or create a health care entity. Provide an overall description of this entity without using the real name (i.e., location, size, profit or nonprofit, years in operation). Do not give the real name of any entity or person you are describing.
2. Using defined quality outcomes and/or patient safety measures, describe the health care entity’s successes and failures. Include identified criteria and data that demonstrate why this entity is successful and in what areas.
3. Using the quality outcomes data, identify a quality or safety area that nursing science can impact. Describe the specific variables.
4. Identify potential obstacles (such as economics or ethical issues) that may hinder the implementation of the quality or safety measure.
5. Identify those groups or leadership roles within the entity with whom you may need to collaborate.

Solution and Sample Answer

Analysis and Application

Introduction

Having addressed the concepts of quality and safety in part 1, part II analyzes the quality outcomes and patient safety measures of a healthcare facility in order to establish its successes and failures besides recognizing the likely obstacles to the implementation of these measures.  Additionally, the second part also endeavors to determine the collaborative efforts that are required to nurture sustainability.

The Healthcare Entity

Best Quality Healthcare Hospital (BQHH) is one of the largest public hospitals in the State of Florida with 1500 inpatient beds. The hospital was founded in the late 1920s and therefore has been operational for about 9 decades. Its ED unit sees over 200 000 patients. Upon arrival, the patients are triaged in line with particular patient acuity categories as prescribed in the Alabama State Department of Health. Priority 1(P1) patients consist of those patients who are critically in need of resuscitation and other immediate management. P2 patients present with acute medical conditions or symptoms that are severe hence their need for medical attentions at the earliest possible time. P3 and P4 patient’s exhibit minor emergency and non-emergency conditions respectively based on the condition of the patient and the PAC score that they have been assigned, the individual is taken to various treatment units within the ED for clinical consultation with the physicians in attendance.

The ED has GP supervising al the treatment areas in the ED. P1 patients are attended to in the resuscitation unit while P2 patients are found in the critical care section. The ambulatory care section is reserved for P3 patient. It is worth noting due to close proximity between each treatment section doctors are able cross cover areas in case of surge periods that may create a treatment imbalance between each treatment section. Furthermore, this ED staffing is informed by patient acuity where 66% of the professionals are allocated to cover P1 and P2 patients.

Successes and Failures of BQHH

 Healthcare is a risk prone business that incorporates sick individuals, skilled fallible professionals working in complex systems with advanced technology where success and failures are determined by avoidance of   errors and design failures that can cost a patient their life. Needless to say harm emanating from the process of delivery care affects every health entity and health system globally.  BQHH is not an exception and while studies report that about 1 out of 10 patient face the possibility of being harmed by the care they receive about 50% of these adverse events are avoidable. Developing a system that achieves zero harm avoidance is unrealistic partly because understanding harm and the types of harm that are avoidable continues to develop on a daily basis (Burström et al., 2016). As such in the context of BQHH the parameters of its success or failures thereof are premised on how well the organization is fairing in persistently and constantly reducing harm to the patients.

[Solved] Quality and Sustainability Paper Part Two Analysis and Application (Sample Answer)

Analysis of measures available within the organization and comparing them with national statistics show that BQHH has achieved significant success.  In 2014, the quality of patient –focused care within the organization was well above the national average in areas of using an approach that is respectful to the values, preferences as well as the expressed needs of the patient, offering emotional support through relieving patient fear and worry experienced by the patients and providing information, education and effective communication (Amaniyan et al, 2019). Majority of the patients also expressed their satisfaction with the hospital ensured their physical comfort and involving the patient’s family and their significant others in the care process.

However, in some areas, some shortcomings were reported by the patients and which the organization needs to address as a matter of priority. These include instances where some of the patients who paid a visit at the ED felt isolated unnecessarily long time was taken before their needs were attended to.  The other patient reported failure was overcrowding within the ED area and the staff manning this unit appeared overwhelmed by the number of patients they were attending to. In spite of these even the patients themselves admitted they were satisfied and welcomed the relieve they got once they were treated. BQHH prides itself in learning from its mistakes and improving on its shortcomings  hence the management identified  reducing the time it took the patient to get treated  once they visited the ED. The proposed project based on the PICOT question ‘How does emergency department wait time greater than two hours compared to those less than two hours affects the rate of LWBS (leave without being seen) or patient satisfaction rate?’ expects to achieve significantly reduced rates of LWBS and increased patient satisfaction within a period of six months.

Impact through Timely Care

            BQHH has P2 patients wait time to consultation (WTC) as key performance indicator whereby the clock begins the moment the patient register on arrival at the ED and stops the moment consultation commences(Sharif & Saberi, 2014). This area has proven to be an area of concern considering that BQHH targeted goal of 95^th centile WTC stands at 124 minutes with a threshold of waiting time of 160 minutes. These targets are formulated using a moving average of the hospital’s WTC within a pre-determined period of time. As the years progress however, the rising number of patients, a population which is ageing who present with greater disease complexity as well as limitations in human resources together with physical infrastructure scarcity have all contributed to making the realization of this target more challenging (Burström et al., 2016). Needless to say ad as stated elsewhere in this paper, prolonged wait times and ED overcrowding are directly linked to patient outcomes that are poorer necessitating a quality improvement team targeted to lower the 95^th centile for P2 patient to less than 100 minutes within a period of 180.  Baseline data from March 2015 to July 2016 will be collected and analysis of 2, 345 P2 patient visits will be done and in order to understand the processes and challenges faced in the ED area, an actual state of analysis will be conducted. All work processes will be assessed and extensive analysis of data performed over 30 days. This will be followed by the creation of value stream map for the P2 patient journey that captures the process flow, time analysis together with analysis of shortcomings (Khalifa & Zabani, 2016). This will then help to highlight likely operational challenges and the areas for improvement. The purpose of the proposed quality improvement quality intervention is to decrease the rate of WTC and rates of LWBS in order to improve patient outcomes and increased patient satisfaction by   posting clinical inter-professional team in triage during times of high number and rapid patient. This is after establishing that WTC of more than two hours directly led to an increased rate of LWBS with lower patient satisfaction rate compared to WTC of less than two hours.

Clinical Inter-professional Team in Triage (CITiT)

At BQHH, there are several barriers that are likely to hinder the successful implementation of the CITiT even with the strategic selection of the CITiT program team members, guaranteed support from the hospital management and a united reporting structure within the ED (Burström et al., 2016). The anticipated barriers include staff resistance, inadequate staffing resources, and failure of past programs that sought to reduce the WTC and patient inflow and the entrenched organizational culture (Islami, 2015). To start with, it is anticipated that some members of the staff will resist the proposed change as some of them regard the proposed changes as resulting in more disruption of the work flow. While every effort will be made to involve all members of the frontline staff within the ED there are those who will feel that their participation was not fully needed and therefore cite lack of awareness amongst others (Nilsen et al, 2019). For example at BQHH there is the open –bed strategy which means that   incoming patients are guided to an open bed when there is one available for triage as well as registration. Tappen et al (2017) point out that scarcity of resources acts a barrier to implementation. The resources allocated for the change initiative have other competing demands which the hospital management and other stakeholders feel need to be balanced (Miake-Lye et al., 2018). Due to financial constraints at BQHH hiring extra staff to be stationed at the ED may not be option. At the same time if previous attempts to reduce the WTC have failed within this facility, the CITiT program during peak hours will have to overcome the cynicism of the staff since this will not be the first time they are participating in a quality improvement project.

[Solved] Quality and Sustainability Paper Part Two Analysis and Application (Sample Answer)

Groups to collaborate at BQHH

After identifying the barriers to quality improvement program and recommended strategies that would overcome each one of the identified barriers, the change champions within the ED will also have to identify the groups to collaborate with and leadership roles that will ensure the CITiT program becomes a success. The nursing staff within the ED has to collaborate with the GPs working in this area without excluding the social worker and other hospital administrative like secretaries (Karam et al, 2017). Through this collaboration mutual acquaintanceship as well as trust is nurtured. The staff agrees that knowing each other maximizes contact in addition to cultivating healthy working relations. The collaboration exercise will also serve to cement the shared objectives of the CITiT in reducing the WTC within the ED. Studies have also established that inter-professional collaboration where multidisciplinary team work modules led to improved outcomes (Liu et al, 2018).

Conclusion

In the analysis and application section, this paper has identified BQHH as the hypothetical healthcare entity whose quality data outcomes will be used to identify the quality and safety area together with its success and failures in 2015 and 2016. Patient reported measurements indicate that the hospital has been successful in offering patient relief from fears and worry, involve the patient’s family in decision making while the patients pointed extended stay in ED making the hospital to come up with the PICOT question of how WTC reduction in this department can be used to reduce patients LWBS rates and increase the patient satisfaction.  CITiT has been identified as the EBP based project meant to improve healthcare quality of timeliness by ensuring the patients are attended to in less than two hours regardless of time of the day. Barriers to the CITiT program are anticipated to be staff resistance, resources shortage and the entrenched organization culture among others. Towards the end of this section, the paper has identified inter-professional and multidisciplinary team collaboration involving physicians, nurses and their assistants as key to the success of the CITiT program.

References ([Solved] Quality and Sustainability Paper Part Two Analysis and Application (Sample Answer))

Amaniyan, S., Faldaas, B. O., Logan, P. A., & Vaismoradi, M. (2019). Learning from Patient Safety Incidents in the Emergency Department: A Systematic Review. The Journal of Emergency Medicine.

Burström, L., Engström, M. L., Castrén, M., Wiklund, T., & Enlund, M. (2016). Improved quality and efficiency after the introduction of physician-led team triage in an emergency department. Upsala journal of medical sciences, 121(1), 38-44.

Islami, X. (2015). The Process and Techniques to overcome the Resistance of Change Research based in the Eastern Part of Kosovo. International Journal of Multidisciplinary and Current Research, 3.

Karam, M., Tricas-Sauras, S., Darras, E., & Macq, J. (2017). Interprofessional collaboration between general physicians and emergency department teams in Belgium: a qualitative study. International journal of integrated care, 17(4).

Khalifa, M., & Zabani, I. (2016). Utilizing health analytics in improving the performance of healthcare services: A case study on a tertiary care hospital. Journal of Infection and Public Health, 9(6), 757-765.

Miake-Lye, I. M., O’Neill, S. M., Childers, C. P., Gibbons, M. M., Mak, S., Shanman, R., … & Shekelle, P. G. (2017). Effectiveness of interventions to improve emergency department efficiency: an evidence map.

Nilsen, P., Schildmeijer, K., Ericsson, C., Seing, I., & Birken, S. (2019). Implementation of change in health care in Sweden: a qualitative study of professionals’ change responses. Implementation Science, 14(1), 51.

Tappen, R. M., Wolf, D. G., Rahemi, Z., Engstrom, G., Rojido, C., Shutes, J. M., & Ouslander, J. G. (2017). Barriers and Facilitators to Implementing a Change Initiative in Long-Term Care Utilizing the INTERACT™ Quality Improvement Program. The health care manager, 36(3), 219.