Running head: QUALITY IMPROVEMENT INITIATIVE PROPOSAL 1
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
Data Analysis and Quality Improvement Initiative Proposal
Learner’s Name
Capella University
Quality Improvement for Interprofessional Care
Data Analysis and Quality Improvement Initiative Proposal
Month, Year
Comment [JS1]: Good job with the
submission. It follows the rubric. For
the most part is written in scholarly
voice. The submission is clear and
concise. References and citations are
used to support your opinion and
position with relevant evidence.
Please see my tracked changes for
areas of revision.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 2
Data Analysis and Quality Improvement Initiative Proposal
I. Introduction
Health care professionals are constantly striving to improve the quality of care and safety
provided to their patients. The culture of care quality and patient safety depends on a strong and
supportive work environment that promotes leadership, evidence-based practice, effective
communication, and interprofessionalism. Nurse leaders play a crucial role in establishing this
culture and directly influence quality outcomes across an organization.
II. Problems and Needs
The role of nurse leaders in maintaining the quality in the nursing and clinical
departments is discussed using the example of TrueWill General Hospital (TGH), a
multispecialty hospital in the United States. As part of an annual assessment of organizational
quality, the hospital’s quality management office completed its analysis of dashboard metrics for
the surgical units for the year 2016–2017. The office released the data in its Quality and Safety
Report 2016–2017. The surgical units’ data included adverse events and near misses and used
four quality indicators: length of stay (LOS) exceeding 7 days, patient readmission rates, pain
level between 7 and 10 for more than 24 hours, and patients with pressure ulcers.
III. Proposed Solution
The results of the analysis showed that three quality indicators—pain levels, readmission
rates, and pressure ulcers—performed below the hospital’s benchmarks (see Table 1 and
Appendix for data and descriptions of indicators and benchmarks). The connection between these
indicators and the services of the surgical units’ nurses will be discussed in this proposal for a
quality improvement initiative. The proposal will analyze the relational patterns between the
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 3
indicators and the data, identify assumptions governing health care quality and nursing
characteristics, determine methods to discover the root causes of quality issues, and recommend
a framework as well as strategies to improve quality outcomes in the surgical units.
Analysis of Dashboard Metrics to Identify Quality Issues
The patients who require round-the-clock perioperative care are admitted to TGH’s
surgical units, which are equipped for general, orthopedic, urologic, and ambulatory surgery. The
critical nature of patients admitted to these units makes quality and safety the units’ highest
goals. Quality and safety outcomes are regularly evaluated. The units are staffed by teams of
interdisciplinary professionals: physicians, nurses, therapists, dieticians, pharmacists, and
ancillary medical staff.
Table 1
Quality and Safety Report 2016–2017
Unit – Year
LOS
exceeding 7
days
Patient
readmission
Pain level
between 7 and
10 for more
than 24 hours
Patients with
pressure
ulcers
Total
Surgical
2015
43 29 15 14 101
Surgical
2016
31 43 30 25 129
The data available from the Quality and Safety Report in Table 1 revealed that the
annual patient readmission rates increased from 29 incidents in 2016 to 43 in 2017. Similarly,
the number of patients who experienced pain for more than 24 hours without relief doubled
from 15 in 2016 to 30 in 2017. Pressure ulcers, a common quality and safety issue in surgical
patients, also increased to 25 from 14 in 2016. Conversely, the units reported a drop in the
number of patients whose LOS exceeded 7 days—from 43 in 2016 to 31 in 2017.
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 4
The outcomes are a cause for concern because they can affect the hospital’s
stakeholders—the patients, health care professionals, and the organization—in various ways.
Patient readmissions are a costly outcome for TGH because the Patient Protection and Affordable
Care Act, through its Hospitals Readmissions Reductions Program, financially penalizes
hospitals with higher than expected readmissions (Bartel, Chan, & Kim, 2014). Hefty penalties
are enforced because readmissions are thought to be the result of poor follow-up care (Abelson,
2013).
Furthermore, studies have found an association between LOS and the risk of
readmissions. Bartel et al. (2014) reviewed prior literature on the impact of decreasing patient
LOS and increasing readmission rates and concluded that a patient who stays for an additional
day may reach a higher level of stability. At TGH, health care professionals may have faced
immense pressure to reduce patient LOS to control per capita health costs. The pressure could
have forced the units’ nurses and doctors to rush through patient care plans and hasten the
process of educating patients regarding post-discharge behavior. Furthermore, patients who are
readmitted may lose trust in the ability of their health care providers to provide complete and
quality care.
Just as readmissions are a quality issue that affects all stakeholders, high pain levels and
pressure ulcers affect the surgical units’ nurses and patients. This inference is based on the theory
of nurse-sensitive patient outcomes, which explains that pain and pressure ulcers are patient
outcomes that depend on the quantity and quality of nursing (Stalpers, de Brouwer, Kaljouw, &
Schuurmans, 2015). Based on this inference, it can be assumed that there could be issues in the
performance and quality of nursing in TGH’s surgical units.
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 5
Moreover, there is evidence linking pressure ulcers and postoperative pain to a higher
risk of readmissions (Kirkner, 2017; Lyder et al., 2012). While TGH’s data do not directly link
pressure ulcers and pain to readmission rates, it is possible to theorize that reducing pressure
ulcers and pain in patients will also reduce readmissions. Therefore, the surgical units’ nurses can
help prevent readmissions by preventing ulcers and managing pain in patients more efficiently.
The standard of nursing quality is an important predictor of favorable quality outcomes.
Based on the analysis of the data in the report, TGH’s nurse leaders met with the units’ nurses to
examine the nursing factors that contributed to the unfavorable outcomes. The nurse leaders
identified the problem to be the transactional leadership style practiced by the perioperative
charge nurses. Transactional leadership is defined as an exchange relationship that clearly
distinguishes the follower from the leader and is focused on the contingent reward system with
individuals being rewarded or punished based on their performance (Thomas, 2016).
Transactional leadership may have become the dominant style of leadership in TGH’s surgical
units because of the lack of training and incompetence among nurses. The nurse leaders decided
to change the leadership style of charge nurses with a quality improvement (QI) initiative based
on the data analysis. The proposal for the QI initiative will identify an ideal leadership style and
propose strategies to implement the style. Knowledge gaps or areas of uncertainty that require
further evaluation will also be discussed in the proposal.
Outline for the Quality Improvement Initiative Proposal
Charge nurses occupy a frontline position in influencing the staff engaged in patient care
(Thomas, 2016). They are responsible for functions such as coordinating and evaluating nurse
staffing plans, balancing unit budgets, and making patient assignments. However, the
transactional leadership at TGH was ineffective because the charge nurses were not skilled
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
Comment [JS2]: This reference is
too old to be viable for relevant
evidence-based practice. In health
care, it is important to use up-to-date
references that are not more than 5
years old. I might suggest finding a
more recent reference.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 6
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
enough to notice nurse dissatisfaction, prevent conflicts and competition among the nurses, or
establish effective communication channels. The surgical units’ nurses were not given any
guidance by the charge nurses on accomplishing quality improvement tasks or participating in
collaborative and interprofessional efforts. Because of the transactional leadership’s tendency to
reward or punish staff based on performance (Thomas, 2016), the nursing staff paid more
attention to accomplishing tasks such as discharging patients quickly than to ensuring patient
satisfaction.
The QI initiative will provide strategies that support the transition from transactional to
transformational leadership. Transformational leaders focus on internalizing ethical and
professional values in their team members and assist in aligning those values with organizational
goals. A transformational leader’s optimism, selfless service, and creativity motivate and
encourage teams. It is worth noting that the motivational and inspirational aspects of
transformational leadership will significantly change the work environment and the nurses’
commitment to the organization (Thomas, 2016).
The quality improvement model that is best suited to introduce and implement
transformational leadership is the Plan-Do-Study-Act (PDSA) model. Hence, the model will
serve as the framework for the QI initiative. The model is effective when there is a need for
accelerated change, as in TGH’s case. The four steps of the framework can effect systemic
change that will promote long-term improvement and implementation of the initiative on a larger
scale. Various strategies incorporated into the PDSA steps will be discussed briefly (Thomas,
2016). 1. Plan: This step involves setting up an interdisciplinary team. While the nurse
leaders already identified the problem to be transactional leadership through
discussions and the analysis, the interprofessional team will validate the previous
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 7
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
results using a Multifactor Leadership Questionnaire survey. The survey will be
distributed to the nurses as well as other perioperative health care professionals.
After the results of the survey are analyzed, the team will define achievable goals
such as establishing a transformational leadership style and improving the
affected quality indicators.
2. Do: In this step, the team, with support from the organization, will create a
strategic plan to achieve the defined goals. Examples of strategies include
introducing training modules for leadership development and quality and safety
education.
3. Study: The results from the implementation of strategies devised in the previous
steps are analyzed. Observations are based on different interprofessional
perspectives and are set against the performances of TGH’s surgical units, not just
nursing.
4. Act: In the final step of the PDSA model, the goals set in step one are reevaluated
to determine whether the strategies were effective. TGH can carry out the step by
calculating data on the four quality indicators and noting increases or decreases in
the quality outcomes. Based on that evaluation, the PDSA cycle is deemed
complete or renewed with new goals and strategies.
Despite the effectiveness of the PDSA model, knowledge gaps and areas of uncertainty
may still affect the QI process. First, the use of just four indicators to measure quality outcomes
in the surgical units can give a partial or narrow understanding of the issues. Further evaluation
should be done using indicators such as mortality and patient satisfaction and nurse-sensitive
indicators such as nurse perception of job and level of nursing education.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 8
Secondly, the data only shows problems affecting the hospital’s surgical units.
Foundational theories such as systems theory explain how problems in one part of the
organization affect performance and quality outcomes in other parts. However, there is a lack of
data on quality issues from other departments at TGH that could be connected to the issues seen
in the surgical unit. Therefore, the team spearheading the QI efforts can take steps to include data
from other units and departments to create a comprehensive QI initiative. Another area of
uncertainty is the studies connecting nursing leadership and patient outcomes. Most studies do
not test whether nursing leadership directly improves patient outcomes; they merely analyze the
connection conceptually. Understanding the relationship between leaders and patient outcomes
requires interventions and longitudinal studies with continuous observations (Wong, 2015).
To achieve better patient outcomes by changing the nursing leadership, the proposed QI
initiative will be guided by various interprofessional perspectives. The perspectives will support
patient safety, cost-effectiveness, and work-life quality for nurses and other units’ staff. Each
perspective will address an aspect relevant to TGH, such as leadership and teamwork. The
discussion will also identify assumptions that highlight the importance of these perspectives.
Integration of Interprofessional Perspectives That Support Quality Improvement
Over the years, efforts to improve health care quality and safety drew inspiration from
various interprofessional perspectives. The perspectives important to TGH are leadership theory,
systems theory, and collaborative relationships. The identification of these specific perspectives
and their integration into the hospital’s QI initiative are based on assumptions made on the
factors that influence patient outcomes.
One assumption is that health care systems are interconnected and problems in one unit
or department can affect other parts of the system (Huber, 2017); problems in the surgical units
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 9
can affect the quality of other hospital departments. When quality is compromised in multiple
departments, the organization will be unable to function properly and achieve its goals of
providing quality and safe care for patients. Poor nursing performance and quality also affect the
performance of doctors, therapists, pharmacists, dieticians, and other interdisciplinary
professionals working in the surgical unit. These health care professionals work alongside nurses
and depend on them to carry out care plans effectively, quickly, and cost-effectively.
Another assumption is that nurse leaders such as charge nurses can learn and develop
leadership attributes (Thomas, 2016) that will help them improve their leadership style.
However, leadership development can only take place if the organization is supportive and
allocates appropriate resources and facilities. The third and last assumption guiding the
conceptual basis of the initiative is that anyone—not just executives or managers—can practice
leadership (Smith-Trudeau, 2016).
The main theme explored in these assumptions is leadership; it is an important systems
theory factor and collaborative relationships are influenced by leadership styles. Although the
connection between leadership and patient safety needs to be further evaluated, experts agree that
certain leadership styles obtain better results than others do. In particular, experts have compared
the effectiveness of transactional leadership to transformational leadership in achieving patient
safety. Transactional leadership, as was observed in TGH, is ineffective, as it focuses on rewards
rather than outcomes. Conversely, transformational leadership engenders a higher level of
competence that helps in guiding and motivating team members to follow a higher level of ethics
and evidence-based care, thereby improving the outcomes for patients (Thomas, 2016).
Transformational leaders are also more competent when introducing cost-reduction plans while
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
10 QUALITY IMPROVEMENT INITIATIVE PROPOSAL
maintaining quality in their units. They are more skilled than transactional leaders at
organizational and administrative management, which is an essential skill for budgeting.
Transformational leadership is also the preferred leadership strategy in implementing
systems theory approaches. Systems theory is important in QI, as it focuses on understanding
root causes and symptoms of quality and performance problems (Huber, 2017). By
understanding latent causes of quality issues, TGH can focus on proactive quality measures that
prevent quality and safety issues in the long term. Such approaches are known to be cost-
effective and sustainable.
Transformational leadership’s focus on people through effective interpersonal
relationships and charismatic influence is also beneficial for establishing collaborations among
teams and developing optimum work-life quality for staff. The surgical units at TGH, consisting
of interprofessional staff, depend on a sense of shared goals among staff. The nurses are the
largest staff group in the surgical units and issues within their workforce such as nonalignment
of goals affect other units’ staff. Transformational leaders are capable of guiding nurses in
building respectful and positive relationships with their colleagues.
These interprofessional perspectives will act as guides for the QI team as they implement
the PDSA steps. The perspectives are especially useful in facilitating open and transparent
communication. The QI proposal will suggest communication strategies that are imperative
when expanding the proposal into a full-fledged QI program. The proposal will also provide
assumptions that will guide those suggestions.
Effective Communication Strategies to Promote Quality Improvement
Communication is a key leadership duty and facilitates the smooth functioning of different
organizational systems (Huber, 2017). Without effective communication methods,
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 11
leaders will not be able to convey organizational goals and decisions or implement QI changes.
At TGH, the charge nurses could not communicate care plans to their nursing staff or coordinate
with other units’ leaders and interdisciplinary professionals to achieve ideal outcomes. Their
ineffective communication methods also set a bad example for the nursing staff, who look to
their leaders for guidance and instruction.
Therefore, it is important to develop communication strategies before the QI strategies
are implemented. Well-defined communication channels will promote interprofessional efforts in
patient care and quality improvement. The assumptions guiding the strategies are as follows: (a)
Leaders facilitate and mediate effective interprofessional collaborations in care delivery, which
can only happen if the leaders are competent in communication skills; (b) Quality improvement
is a resource-intensive effort, but coordinating and utilizing those resources requires open and
honest communication among organization, patients, and interprofessional staff; (c)
autonomy in decision making is important for improving the performance of nursing staff, but
autonomy is a product of mutual respect and effective communication among all
interprofessional staff, including management and administrative staff.
Based on these assumptions, a few communication strategies to implement the QI
initiative and promote interprofessional care or teamwork are recommended. The strategies are
as follows: (a) training the QI team in verbal, nonverbal, written, and electronic means of
communication, which will improve relations within the team and will be useful during
interprofessional collaborations; (b) setting up team documentation, where all team members
will enter details of ideas, meeting minutes, and QI-related data; during the Do stage of the
PDSA, team documentation will be implemented at the unit level and all staff present during a
patient visit will enter details into the patient record, assist with order entry, and
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 12
process prescriptions (Bodenheimer & Sinsky, 2014); (c) setting up a weekly QI team meeting
where team members will receive a copy of the agenda in advance and provide feedback on
meeting goals; post-meeting, members will be sent copies of all communication via e-mail to
maintain transparency (Thomas, 2016); and (d) briefing units’ staff on decisions made in these
meetings and, when needed, e-mailing summaries of the meeting minutes to all staff members so
specific groups or individuals will not feel excluded from the QI efforts.
As the QI process progresses, the team can add more communication strategies into the
PDSA model or make improvements to the existing strategies. After all, the PDSA model for
quality improvement was selected because it allows experimentation, quick pilot testing of plans,
and implementing the plans on a larger scale after analyzing the results (Thomas, 2016). The
onus of organizing and coordinating the QI efforts falls on the nurse leaders heading the team.
They must develop their leadership competency to inspire similar changes in the charge nurses.
IV. Conclusion
Data- and outcome-driven organizations must constantly analyze their quality indicators
and implement changes that improve all clinical and organizational outcomes. Quality and safety
evaluations, such as the one conducted at TGH, often reveal hidden issues that are influencing
patient outcome negatively, such as ineffective leadership styles. Leadership is important in
uncovering the latent problems and implementing changes that improve quality and safety.
However, as displayed at TGH, leadership itself depends on factors such as interprofessional
care and teamwork, communication, and highly qualified health care professionals. The absence
of these factors can affect patient outcomes drastically. Understanding this interdependence
among organization, leadership, and staff is key to high-quality performance and patient safety.
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 13
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
References
Abelson, R. (2013, March 29). Hospitals question Medicare rules on readmissions. The New York
Times. Retrieved from http://nytimes.com/2013/03/30/business/hospitals-question-
fairness-of-new-medicare-rules.html
Bartel, A. P., Chan, C. W., & Kim, H. (2014, September). Should Hospitals Keep Their Patients
Longer? The Role of Inpatient and Outpatient Care in Reducing Readmissions (Report
No. 20499). Retrieved from the National Bureau of Economic Research website:
http://nber.org/papers/w20499
Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires
care of the provider. Annals of Family Medicine, 12(6), 573–576. Retrieved from
https://ncbi.nlm.nih.gov/pmc/articles/PMC4226781/
Huber, D. L. (2017). Leadership and nursing care management (6th ed.) Philadelphia: W.B.
Saunders. http://dx.doi.org/10.7748/nm.21.6.13.s14
Kirkner, R. M., (2017, May 7). Postop pain may be a predictor for readmission. ACS Surgery
News. Retrieved from http://mdedge.com/acssurgerynews/article/137637/pain/postop-
pain-may-be-predictor-readmission
Lyder, C. H., Wang, Y., Metersky, M., Curry, M., Kliman, R., Verzier, N. R., & Hunt, R. H.
(2012). Hospital‐acquired pressure ulcers: Results from the national Medicare patient
safety monitoring system study. Journal of the American Geriatrics Society, 60(9), 1603–
1608. Retrieved from http://henlearner.org/wp-content/uploads/2012/03/hospital-
acquired-pressure-ulcers.pdf
Smith-Trudeau, P. (2016). leadership at all levels: The art of self-leadership. Vermont
Nurse Connection, 19(4) 4–5. Retrieved from
Comment [JS3]: I would suggest
locating a more recent reference.
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 14
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
http://web.a.ebscohost.com.library.capella.edu/ehost/pdfviewer/pdfviewer?vid=1&sid=63
1c6937-3dbc-466d-ba31-b5e5aec17013%40sessionmgr4010
Stalpers, D., de Brouwer, B. J. M., Kaljouw, M. J., & Schuurmans, M. J. (2015). Associations
between characteristics of the nurse work environment and five nurse-sensitive patient
outcomes in hospitals: A systematic review of literature. International Journal of
Studies, 52(4), 817–835. Retrieved from
http://sciencedirect.com.library.capella.edu/science/article/pii/S0020748915000061?_rdo
c=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa
92ffb&ccp=y
Thomas, C. D. (2016). Transformational leadership as a means of improving patient care and
nursing retention (Doctoral dissertation). Retrieved from ProQuest. (Order No.
10125747).
Wong, C. A. (2015). Connecting nursing leadership and patient outcomes: State of the
science. Journal of Management, 23(3), 275–278. Retrieved from
http://onlinelibrary.wiley.com.library.capella.edu/doi/10.1111/jonm.12307/full
QUALITY IMPROVEMENT INITIATIVE PROPOSAL 15
Copyright ©2017 Capella University. Copy and distribution of this document are prohibited.
Appendix
Description of Quality and Safety Report 2015–2016
The Quality and Safety Report data for the year 2015–2016 represents four recognized
quality indicators in health care. The calculations are based on the total number of adverse events
and issues, differentiated by type, documented in TGH’s surgical units for 2015–2016. The
length of stay is calculated for patients who are admitted for more than 7 days. Patient
readmissions describe revisits by former surgical patients to the emergency department or
surgical units within 30 days of their discharge. The revisiting patients may sometimes require
additional hospital stay, which might be related to their surgical procedures.
The third indicator is based on medical pain where pain is rated on a scale of one to 10—
one being the mildest pain and 10 the most severe. TGH chose numbers between 7 and 10 on the
scale because a pain level between 7 and 10 that lasts for more than 24 hours is considered a
patient safety issue. The final indicator denotes pressure ulcers, which are injuries caused to skin
tissue resulting from prolonged pressure on the area. Patients bed-ridden after medical
procedures are at high-risk of pressure ulcers. The ideal benchmark for each indicator is zero,
which means that the goal of TGH is to prevent extended stays, readmissions, prolonged pain
without relief, and pressure ulcers in surgical patients.
Delivering a high-quality product at a reasonable price is not enough anymore.
That’s why we have developed 5 beneficial guarantees that will make your experience with our service enjoyable, easy, and safe.
You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.
Read moreEach paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.
Read moreThanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.
Read moreYour email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.
Read moreBy sending us your money, you buy the service we provide. Check out our terms and conditions if you prefer business talks to be laid out in official language.
Read more