NURS 6231: Healthcare Systems and Quality Outcomes

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NURS 6231: Healthcare Systems and Quality Outcomes

NURS 6231 Entire Course Weekly Discussions And Assignments

NURS 6231 Week 1: Leadership Strategies for Quality Outcomes, Part 1

The tragic death of a young child in 2001 generated decisive action to promote patient safety and improve health care quality.

As Dr. Peter Pronovost and Eric Vohr explain, “Josie King’s death had a significant impact on Johns Hopkins. Like all hospitals, Hopkins was no stranger to medical errors. However, the senseless death of this eighteen-month-old child affected nurses, physicians, and administrators at all levels. Perhaps it was her tender young age, or the bonds that had formed between doctors, nurses, and the King family during that agonizing month before she died. Or perhaps this error shined a spotlight on the communication and teamwork failures that clearly harm patients; perhaps the time had come for a change” (Pronovost and Vohr, 2010, p. 20).

An examination of the events leading up to Josie King’s death sheds light on how organizational structure and culture, communication between care team members, and interactions with patients and families may help or hinder efforts to keep patients safe and provide high-quality care.

This incident stands out not only as an indication of the life-and-death significance of health care delivery, but also as an exemplar of how health care professionals can join together to do what is right and just on behalf of the patients and families they serve. In the wake of Josie King’s death, Dr. Peter Pronovost and other leaders partnered with her family to create meaningful, sustainable change not just at Johns Hopkins, but throughout the United States.

You, too, can leverage your strengths to provide effective leadership that fosters patient safety and quality of care. This week, you engage in assessment and self-reflection to identify your leadership strengths and determine how they can be applied to promote health care quality.

Learning Objectives

Students will:

  • Evaluate leadership strengths
  • Evaluate strategies for applying strengths-based leadership to improve patient safety and quality of care in health care systems

NURS 6231: Healthcare Systems and Quality Outcomes

It is relatively easy to describe our acquired expertise, but most of us struggle when asked to describe our natural talents.

—Rath, 2007, p. 21

Recognizing innate talents is critical not only for leveraging one’s own strengths, but for fostering a workplace environment in which everyone’s contributions are respected and maximized. This is valuable because “the opportunity for individuals to play to their strengths most of the time is the key factor that shows the greatest correlation to outstanding performance in the widest range of business outcomes including profits, productivity, customer satisfaction, and safety and employee retention” (Buckingham, 2011, p. 5).

Charged with the complex and considerable goal of promoting health care quality and safety, nurse leader-managers must learn how to draw upon each person’s strengths to foster collaboration toward this shared purpose.

In this Discussion, you assess your own strengths and consider how they can be applied in a health care organization to improve quality and safety.

To prepare:

  • Review the Learning Resources focusing on strengths-based leadership.
  • If you have not already done so, follow the instructions in Strengths Finder 2.0 to complete the online assessment and read the sections in Part II that are associated with your five top strengths.
  • Consider the results of the assessment. What insights, questions, or concerns arise as you think about these results?
  • Think about how your identified strengths relate to your current role as a leader-manager and to the professional contributions that you hope to make now and in the future. Give focused attention to patient safety and health care quality; how and why are your strengths valuable for promoting optimal patient outcomes and creating systems-level change?
  • Evaluate strategies for applying your strengths in the health care workplace. Identify at least two that you can use to add value to a team or workgroup to improve quality and safety.

By Day 3

Post a brief description of your identified strengths and explain how and why they are beneficial in your role as a nurse leader-manager. Explain at least two strategies for applying your leadership strengths in a health care organization to improve quality and safety.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

  • Ask a probing question substantiated with additional background information or research.
  • Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
  • Validate an idea with your own experience and additional resources.

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NURS 6231: Healthcare Systems and Quality Outcomes

NURS 6231 Week 2: Leadership Strategies for Quality Outcomes, Part 2

Seventy-One Percent of Employers Say They Value Emotional Intelligence Over IQ

—CareerBuilder, 2013

Appreciative Inquiry is strength-based change. It involves: appreciating, envisioning, co-constructing and sustaining. It is action oriented after dreaming about possibilities. So, these dreams guide and inspire action.

—Jerry Jennings, 2011

As demonstrated last week, you have the power to leverage your strengths—and others’—to promote patient safety and health care quality. Emotional intelligence is another leadership skill valued in today’s workplace, as is the ability to apply appreciative inquiry. Emotional intelligence and appreciative inquiry can generate a deep, nuanced understanding of what is needed to promote health care quality.

This week, you examine how leader-managers may develop emotional intelligence and apply appreciative inquiry to facilitate positive outcomes in health care.

Learning Objectives

Students will:

  • Apply emotional intelligence to facilitate positive outcomes for health care issues
  • Apply appreciative inquiry to facilitate positive outcomes for health care issues

NURS 6231: Healthcare Systems and Quality Outcomes

Through communication—inquiry and dialogue—every person makes a contribution, and by being involved in the process, people can shift their attention and action away from a problem-oriented focus to dreams that are worthy to them and to productive possibilities for the future.

—Watkins & Mohr, 2001

Without a doubt, promoting health care quality and patient safety presents a meaningful aim.

To achieve this goal, nurse leader-managers need to be able to evaluate a situation from many different viewpoints and frame questions that elicit valuable insights. They must be able to promote skillful problem solving and interdisciplinary teamwork.

In this Discussion, you examine how you can use emotional intelligence and appreciative inquiry to facilitate positive changes that lead to improved quality and safety.

To prepare:

  • Review the information on emotional intelligence and appreciative inquiry presented in this week’s Learning Resources.
  • If you have not already done so, follow the instructions in the course text, Emotional Intelligence 2.0 to complete the online assessment.
  • Consider the results of the assessment. Review your strengths and opportunities for growth related to self-awareness, self-management, social awareness, and relationship management. What insights, questions, or concerns arise as you think about these results?
  • Think about how your identified emotional intelligence strengths and opportunities for growth relate to your current role as a leader-manager and to the professional contributions that you hope to make now and in the future. Give focused attention to patient safety and health care quality. How and why is emotional intelligence valuable for promoting optimal patient outcomes and creating systems-level change?
  • As indicated on pages 53–55 of the Bradberry and Greaves text, develop a plan for improving your skills in one area of emotional intelligence. Evaluate strategies for applying your strengths in the workplace. Identify at least two that you can use to add value to a team or workgroup to improve quality and safety.
  • Also review the information on appreciative inquiry in this week’s Learning Resources. Have you used appreciative inquiry before? If so, how? How does the application of appreciative inquiry relate to your role as nurse leader-manager and/or to efforts to promote health care quality?
  • Reflect on your experiences working in health care and identify an issue or problem that required, or requires, a change. Consider how you could apply emotional intelligence and appreciative inquiry strategies to this situation to facilitate positive results that lead to improved quality.

By Day 3

Post a brief description of an issue or problem in a health care setting that required, or requires, a change. Explain how you, as a nurse leader-manager, could apply both emotional intelligence and appreciative inquiry strategies to address this issue and facilitate positive results that lead to improved quality.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

  • Ask a probing question, substantiated with additional background information or research.
  • Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
  • Validate an idea with your own experience and additional resources.

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NURS 6231: Healthcare Systems and Quality Outcomes

NURS 6231 Week 3: Organizational Systems and Structures, Part 1

Within every health care organization exists a web of systems and structures that facilitate the delivery of patient care. This week, you begin to examine how the various components of an organization contribute to—and sometimes hinder—patient safety and quality. To that end, you compare a variety of frameworks that can be used to analyze an organization and, ultimately, improve performance.

As you proceed through this course, you will develop a comprehensive project related to quality improvement. This week, you begin to analyze an organization that will serve as the focus for your project.

Learning Objectives

Students will:

  • Compare frameworks used to analyze organizations
  • Evaluate the effectiveness (usefulness) of frameworks to improve performance
  • Analyze the systems and structure of a health care organization*

*This learning objective will be assessed in Week 4.

NURS 6231: Healthcare Systems and Quality Outcomes

Avedis Donabedian’s work generated a pivotal means of assessing organizational performance relative to structure, process, and outcomes. However, it is clearly not sufficient to view health care quality merely in terms of outcomes—the structures and processes that facilitate these outcomes are equally as important.

In this Discussion, you consider multiple frameworks that can be used to analyze an organization. As you proceed, consider how these frameworks allow you to examine the interplay of interdependent and related parts and processes that comprise the systems within an organization, as well as the arrangements or structures that connect these parts.

To prepare:

  • Investigate and reflect on the systems and structures of an organization with which you are familiar. Consider the following:
    • What is the reporting structure?
    • Who holds formal and informal authority?
    • How many layers of management are there between the frontline and the highest office-holders of the organization?
    • How are interdisciplinary teams organized?
    • How is communication facilitated?
    • How well integrated is decision making among clinical personnel and administrative professionals?
    • How are particular service lines organized?
    • Which departments, groups, and/or individuals within the organization are responsible for monitoring matters related to performance, such as quality and finances?
  • Select two of the following frameworks:
    • Learning organizations, presented in the Elkin, Haina, and Cone article
    • Complex adaptive systems (CAS), presented in the Nesse, Kutcher, Wood, and Rummans article
    • Clinical microsystems, presented in the Sabino, Friel, Deitrick, and Sales-Lopez article
    • Good to great, presented in the Geller article
    • The 5 Ps, presented in the ASHP Foundation article
  • Review the Learning Resources for each of the frameworks that you selected. Also conduct additional research to strengthen your understanding of how to use each framework to assess an organization.
  • Compare the two frameworks. How could each framework be used to identify opportunities to improve performance? In particular, how would you use each of these frameworks to analyze the organization that you have selected?

By Day 3

Post an analysis of the systems and structures of the organization you selected, sharing specific examples. Explain insights that you gained by comparing the two frameworks, and how each can be used to assess an organization, identify a need for improvement, and, ultimately, enhance the performance of an organization.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

  • Compare the organizational structure of your colleague’s selected organization to your own.
  • Ask a clarifying question.
  • Select an attribute of the identified organizational structure and ask your colleague to elaborate on how this attribute is evidenced in their organization.

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NURS 6231: Healthcare Systems and Quality Outcomes

NURS 6231 Week 4: Organizational Systems and Structures, Part 2

As Edgar Schein points out in his seminal work Organizational Culture and Leadership, both the Egyptians and the Mayans built pyramids. It would be easy to make the assumption that the building of pyramids must have similar meaning. However, in some cultures, pyramids housed tombs, while in others, they were temples. Within each culture, the meaning of the pyramid was likely evident, but to an outsider’s eye, incorrect assumptions could be made rather easily.

Last week, you began to analyze an organization’s systems and structures as groundwork for promoting patient safety and health care quality. The culture of an organization is also critically important. Leader-managers must understand the nuances of an organization’s culture to effectively address organizational issues.

This week you examine the influence of culture on the organization, and on efforts to promote positive systems-level change.

In addition, this week you continue your evaluation of a health care organization and identify a quality improvement issue to inform development of your Course Project.

Learning Objectives

Students will:

  • Analyze essential elements of organizational culture
  • Evaluate the influence of organizational culture on achieving organizational goals
  • Analyze strategies for aligning organizational culture with quality improvement initiatives
  • Identify a quality improvement issue in a health care setting

NURS 6231: Healthcare Systems and Quality Outcomes

A company’s culture is often buried so deeply inside rituals, assumptions, attitudes, and values that it becomes transparent to an organization’s members only when, for some reason it changes.

—Rob Goffee

Culture is embedded within every organization. Yet, because culture is woven throughout the everyday interactions and atmosphere of an organization, it can be difficult to assess and explain how the culture influences the inner workings of the organization.

As a nurse leader-manager, developing a sound understanding of an organization’s culture can help you to achieve quality improvement initiatives and identify strategies for enacting sustainable change.

For this Discussion, you analyze the culture of an organization and consider how this relates to achieving goals related to quality improvement. You may wish to focus on the same organization that you have selected for your Course Project.

To prepare:

  • Review the information on organizational culture in this week’s Learning Resources.
  • Reflect on the culture of an organization with which you are familiar. Consider the following:
    • What elements of the organization’s culture seem most prominent or significant to you?
    • What beliefs, dispositions, and/or actions seem to be most valued? Why do you think so?
    • What do you notice about the expectations, assumptions, and more demonstrated among people within the organization?
    • What artifacts provide clues about the culture?
    • How do these cultural elements contribute to or detract from the organization’s ability to meet prominent goals and objectives?
  • Consider how you, as a nurse leader-manager, could apply your knowledge of this culture to facilitate quality improvement initiatives within this organization. How would you leverage the strengths of the culture, and address limitations or obstacles that may arise within it?

By Day 3

Post an analysis of the culture of the organization that you selected. Explain how you think this particular culture contributes to or detracts from the organization’s ability to meet goals. Explain how you, as a nurse leader-manager, could utilize your knowledge of this culture to facilitate quality improvement initiatives within this organization.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

  • Analyze similarities and differences between your colleague’s organizational culture and the organization that you selected.
  • Ask a probing question, substantiated with additional background information or research.
  • Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
  • Suggest leadership strategies that your colleague could use to overcome obstacles in the organization’s culture to facilitate quality improvement initiatives.

Project 1: Promoting Health Care Quality

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

By Day 7

Submit your Project.

Project 2: Promoting Health Care Quality

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 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:
    • What has captured your attention in meetings, reports, and/or daily activities?
    • 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?
    • 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.

By Day 7

Submit your Project.

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NURS 6231: Healthcare Systems and Quality Outcomes

NURS 6231 Week 5: Positive Deviance

Positive deviance? An awkward, oxymoronic term. The concept is simple: look for outliers who succeed against all odds.

—Pascale, Sternin, & Sternin, 2010, p. 3

The first four weeks of this course have focused on deepening and broadening your knowledge of an organization, as well as the strengths and leadership capabilities available within the organization. This provides a foundation for cultivating sustainable change that leads to improved quality and safety. With this essential context in mind, you can begin to explore the boundaries of what is currently being done within the organization and consider how to move beyond the status quo.

This week, you examine the concept of positive deviance and consider how it could be applied to a health care quality problem or issue.

Learning Objectives

Students will:

  • Apply positive deviance to a health care quality problem or issue

Focus on the successful exceptions (i.e., positive deviants), not the failing norm.

—Pascale, Sternin, & Sternin, 2010

Positive deviants—those who are able to innovate and create affirmative results—do so within the same constraints that others face. These outliers reveal how the desired outcomes can be achieved by expanding beyond the boundaries of the status quo, while maintaining a focus on what is professionally, legally, and morally appropriate.

Consider the following example:

In 1990, Save the Children (SC), a nongovernmental organization in the United States, was asked by the government of Vietnam to create a program to enable poor villages to solve the overwhelming problem of childhood malnutrition. Given just six months to create a sustainable solution, those involved realized that they needed to look at the positive results that some had been able to achieve relative to the lack of success others had encountered under similar circumstances. They posed the question: “If some individuals in a community were better able to solve problems than others with access to exactly the same resources, could we use that provocative discrepancy?” Taking this tack, they were able to identify approaches that differed from the norm and apply this knowledge to produce positive results that led to a dramatic improvement in child health (Dura, Singhal, and Sternin, 2009).

In this Discussion, you examine a health care problem or issue and consider how you could apply the concept of positive deviance to produce systems-level change that leads to improved quality.

To prepare:

  • Review the information in this week’s Learning Resources, including the first chapter in Pascale, Sternin, and Sternin book and the Bradley, Curry, Ramanadhan, Rowe, Nembhard, and Krumholz article.
  • Reflect on health care quality problems or issues that warrant systems-level change. Consider the significance of each problem/issue. Identify one, in particular, that you would like to focus on for this Discussion. Note: You may use the quality improvement issue that you selected for your Course Project, if appropriate.
  • With this problem or issue in mind:
    • How would you apply the principles of positive deviance to address this problem/issue? What specific steps would you take to move from identification of the problem/issue through evaluation of outliers to implementation of a larger scale change to improve quality?
    • What examples of positive deviance, if any, are you aware of related to this problem/issue? Conduct research as necessary to see if you can locate one or more instances of positive deviance.

By Day 3

Post a brief description of the health care quality problem or issue you selected and explain how it could be addressed using the principles of positive deviance.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

  • Ask a probing question, substantiated with additional background information or research.
  • Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
  • Validate an idea with your own experience and additional resources.

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NURS 6231: Healthcare Systems and Quality Outcomes

NURS 6231 Week 6: The Quality Movement

Quality is a multifaceted concept that often means differing things to diverse stakeholders. Think about what quality entails for a range of products (e.g., food, television sets, cars) and processes (e.g., the construction of airplanes, how customer service calls are handled for a utilities company).

In health care, as in other industries, quality can be defined and measured in varying ways. Yet, agencies and organizations have come together in recent years to try to promote shared, achievable goals for quality. This week, you examine the standards proposed by leading agencies concerned with health care quality and safety, and consider how quality is or could be defined and measured in specific organizations.

Learning Objectives

Students will:

  • Analyze methods for measuring quality
  • Apply appropriate measures to a quality improvement initiative*
  • Evaluate approaches for collecting and evaluating data for quality improvement initiatives*

NURS 6231: Healthcare Systems and Quality Outcomes

Quality is never an accident. It is always the result of intelligent effort.

—John Ruskin

Quality is multidimensional and involves the perspectives of various stakeholders, including patients and families. As noted in this week’s Learning Resources, defining quality is not a simple, straightforward task. Yet, it provides an essential foundation for being able to measure and assess quality, and, ultimately, to improve it.

In this Discussion, you consider definitions and measurements of quality. As you proceed, think about why it is important for organizations to be able to quantify quality and compare current performance to previous performance, to a set of standards, and/or to performance in other organizations.

To prepare:

  • Review the information in the Learning Resources, especially the chapters in the Sadeghi, Brazi, Mikhail, and Shabot course text, focusing on how quality is or could be defined and measured.
  • Think about a health care organization with which you are familiar. It may be the same organization you are focusing on for your Course Project, or a different one. How do you think various stakeholders in this organization would define quality? How would you define quality as it relates to this organization?
  • Review the information on quality standards and / or aims in the Learning Resources, and consider the following:
    • Which outcomes related to quality are currently being monitored in the organization that you have selected?
    • How is related data collected and evaluated?
    • Does the organization use health information technology in this regard? If so, how?
    • How is quality-related information (e.g., data, needs for improvement) communicated throughout the organization?
    • What do you consider to be the strengths and weaknesses of the current approach to quality in this organization?

By Day 3

Post a definition of quality for your selected organization. Describe at least one quality-related measure that is currently being monitored within the organization. Summarize the data collection process for this measure, and explain how this information is communicated to or among the staff. Identify at least one strength and one weakness related to how quality is defined, measured, and/or monitored within the organization.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

  • Compare the organizations’ definitions of quality.
  • Share an insight about how your colleague’s data and information could be used to formulate a quality initiative.
  • Suggest additional options for tracking data.
  • Provide an additional resource to assist a colleague with his or her plan for keeping staff informed and engaged.

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NURS 6231: Healthcare Systems and Quality Outcomes

NURS 6231 Week 7: Improvement Science

At Pacific Oaks hospital, an interdisciplinary team has identified a need to decrease pressure ulcer rates. Angelica, a nurse leader-manager at the hospital, wonders if there is an issue with the procedures and processes that they currently use to deliver care. If so, she ponders, how can they identify where the trouble lies? And, what will it take to hasten improvement once they have identified the problem?

This week, you examine improvement models and evaluate their effectiveness for promoting quality and safety.

As you consider improvement models this week, think about work situations that you have experienced which involved unnecessary, redundant, or incomplete processes. How do you think this may have affected outcomes?

Learning Objectives

Students will:

  • Evaluate improvement models
  • Evaluate the influence of improvement models on quality and safety in health care
  • Apply improvement models to quality-related issues*
  • Analyze evidence-based strategies for quality improvement*

*These Learning Objectives are assessed in Week 8.

NURS 6231: Healthcare Systems and Quality Outcomes

…while all changes do not lead to improvement, all improvement requires change.

—United States Agency for International Development

Improvement science models bring together research and evidence-based practice to identify the most effective ways to promote quality and safety in health care. As a central tenet of quality improvement, attention must be paid to the processes that contribute to outcomes.

In this Discussion, you examine quality improvement models and evaluate how they could be applied to address specific issues within health care organizations.

To prepare:

  • Review the improvement models presented in the Learning Resources.
  • Evaluate each of the models and select two on which to focus for this Discussion.
  • Consider how each of the two models could be utilized in a health care organization to promote quality and safety. Think about the following:
    • How does the model bring together research and evidence-based practice to facilitate quality improvement?
    • How does the model contribute to a culture of quality and safety?
    • How does it address changes in process?
  • Reflect on the quality improvement issue and the health care setting that you are addressing for your Course Project. Of the two models that you have selected, determine which one you, as a nurse leader-manager, would use to address this issue. Also consider how this would relate to one or more of the IOM’s six aims for quality and safety.

By Day 3

Post your analysis of how the two improvement models that you selected could foster a culture of quality and patient safety and facilitate changes in process that promote positive outcomes. Explain how you would use one of these models to address the quality improvement issue in the organization that you have selected for your Course Project, and how doing so would relate to one or more of the IOM’s six aims for improving quality and safety.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

  • Offer additional strategies for using your colleague’s selected model to address the IOM’s six aims for quality.
  • Share insights for engaging frontline staff using your colleague’s selected improvement model.
  • Compare the steps in the improvement model that you selected with your colleague’s.
  • Suggest an alternative model for your colleague to utilize in his or her identified health care organization.

Project: Promoting Health Care

Section 3: Quality Measurement and Assessment

This week you continue working on Section 3 of your Course Project, which was introduced in Week 6. Through your work in previous weeks of this course, you have likely gained critical insights into the organization that serves as the focus for your quality improvement plan. Integrating this knowledge of the organization into your plan for addressing a quality improvement issue is essential for successfully facilitating change.

As you deepen your analysis of your selected organization, consider how the information presented in this week’s Learning Resources relates to strategic priorities as well as to the uniquely collaborative and competitive dynamic that binds organizations in health care.

To prepare:

  • Think about the quality improvement issue that you are addressing and the associated plan that you are developing. Consider the following:
    • What is the overall purpose, or aim, of doing this work?
    • What would you hope to achieve for the organization by undertaking this project? What are the objectives of this initiative?
    • What value would this work add to the organization?
    • 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:
    • Actual historical and current data and/or a description of the methods that you would use to collect and analyze the data
    • 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. 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

Through your work on Section 3 of the Course Project, you have examined the gap between current performance and evidence-based targets and considered how addressing this gap relates to organizational priorities and large-scale aims for quality improvement.

In this section of the Course Project, you begin to think about quality improvement strategies that could help to bridge this gap. As noted in the Sadeghi, Barzi, Mikhail, and Shabot text, this is referred to as performance-driven planning.

Since the publication of the Institute of Medicine’s report “Crossing the Quality Chasm,” a good deal of attention has been paid to the need to examine processes that contribute to outcomes (Ernst, Wooldridge, Conway, Dressman, Weiland, Tucker, and Seid). As the USAID has noted, interventions “will not create the desired outcome to improve the quality of care unless the overall process of care delivery is also improved.” Therefore, attention to process redesign is a central aspect of cultivating strategies for improvement.

To prepare:

  • 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 you identified in Section 3 (Week 6).
  • Based on the above, start to think of specific evidence-based strategies that could be implemented to close/minimize the performance gaps 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.

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NURS 6231: Healthcare Systems and Quality Outcomes

NURS 6231 Week 8: Process Mapping

Process mapping is not an easy undertaking. It is the perfect combination of business acumen and art. It takes special talent to interview individuals and get them to explain exactly what they do in their job every day, as well as share their pains and express their wants.

—iSixSigma, 2010

As noted in Week 7, evaluating and redesigning processes is often a necessary part of any effort to improve quality outcomes. This week you consider the value of using process maps to identify changes that may be needed and to evaluate the results once quality improvement strategies have been implemented.

Learning Objectives

Students will:

  • Analyze the benefits of using process maps
  • Formulate appropriate approaches for collecting and evaluating data for process redesign that leads to improved quality
  • Apply appropriate measures to a quality improvement initiative
  • Evaluate approaches for collecting and evaluating data for quality improvement initiatives
  • Apply improvement models to quality-related issues
  • Analyze evidence-based strategies for quality improvement
  • Apply process mapping to promote quality improvement

NURS 6231: Healthcare Systems and Quality Outcomes

Given the synergistic relationship between process and outcomes, leader-managers and other team members need to evaluate processes related to care delivery, customer service, and other matters in order to diagnose problems and effectively improve quality.

A process map is a visual representation that illustrates activities and practices as they occur, which serves as a valuable resource for identifying trouble spots. It is important to note that process maps can also be used for evaluation after an intervention has been implemented. For instance, looking at a process map following an intervention may help leader-managers to note discrepancies between what was planned and what is actually being practiced, or to see that a process has in fact improved, even if the outcomes have not met the targets.

In this Discussion, you examine how process mapping could be applied to your Course Project.

To prepare:

  • Review the Learning Resources, focusing on the use of process maps for improving quality and safety.
  • Bring to mind your work on your Course Project thus far. How could you use a process map to diagnose problems and inform strategies for improvement? In addition, think about how using a process map could inform and enhance your data collection efforts.
  • Conduct additional research on this topic to support your thinking.

By Day 3

Post an explanation of how using a process map could inform and facilitate quality assessment and improvement, including data collection efforts, related to your Course Project. Support your response with evidence from the literature.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

  • Ask a probing question, substantiated with additional background information or research.
  • Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
  • Validate an idea with your own experience and additional resources.

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NURS 6231: Healthcare Systems and Quality Outcomes

NURS 6231 Week 9: Evaluating Outcomes

How do you ascertain whether a quality initiative has achieved the desired outcomes and produced benefits that outweigh the costs associated with the endeavor? How do you determine if any unintended consequences have arisen? And, why is it important to communicate the results with various stakeholders?

Evaluation is a critical component of any quality improvement plan. This week, you examine evaluation tools that can be used to monitor quality improvement efforts, and consider how to appropriately measure outcomes. In addition, you explore the value of metrics for communicating this information.

Also this week, you continue to develop your Course Project by synthesizing your analysis and recommendations into an action plan for a quality improvement initiative.

Learning Objectives

Students will:

  • Analyze the benefits of applying evaluation tools to quality improvement initiatives
  • Apply evaluation tools to quality improvement initiatives*
  • Analyze the financial implications of quality in health care organizations*
  • Synthesize analysis and recommendations into a quality improvement action plan*

NURS 6231: Healthcare Systems and Quality Outcomes

Like most other things in life, outcomes are the bottom line with respect to measurement of success along the path of quality improvement. However, without a careful analysis of the link between access, process, and structure of care, improvements in outcomes seem unattainable.

—Sadeghi, Barzi, Mikhail, & Shabot, 2013

In this Discussion, you consider how to collect and analyze qualitative and quantitative data to evaluate the results of quality improvement initiatives. In addition, you discuss the significance of evaluation and how you, as a nurse leader-manager, can contribute in an organization to the large-scale goal of facilitating quality improvement.

To prepare:

  • Review methods for measuring and evaluating quality improvement efforts presented in the Learning Resources. Pay particular attention to how and why it is important to measure outcomes.
  • Select one evaluation tool and analyze its benefits and relevance for the quality improvement plan you are developing for your Course Project.
  • Consider how you, as a nurse leader-manager, can use the results from the evaluation to support the organization’s overarching goals for quality improvement.

By Day 3

Post a brief description of the evaluation tool that you selected. Explain the benefits of applying this tool as part of your quality improvement plan in the Course Project. Also explain how you could use the results from the evaluation to support the organization’s overarching goals for quality improvement.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

  • Suggest an alternative evaluation tool and support your suggestion with evidence from current research literature.
  • Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
  • Validate an idea with your own experience and additional resources.

NURS 6231: Healthcare Systems and Quality Outcomes

Project: Promoting Health Care Quality

Section 5: Evaluation Plan

With the recognition of the bidirectional link between quality and finance in a healthcare organization, it follows that any changes to one can have an echo in the other. To determine the net result of a change in overall performance status of the organization, one must determine the point where the results of echoes will reach equilibrium.

—Sadeghi, Barzi, Mikhail, & Shabot, 2013

This week you have been examining evaluation tools and how they can be used as part of a plan to promote quality and safety. As you develop an evaluation plan for your Course Project, consider the insights you have gained through your analysis of your selected organization, as well as the highly regulated and competitive health care environment.

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:
    • Which stakeholders need information related to this initiative? What do they need this information for?
    • How would you assess the outcomes in the short-term and long-term?
    • How would you analyze related processes, including but not limited to the one you redesigned in Section 4?
    • How should an analysis of organizational structures be integrated into your evaluation?
    • How would you identify and evaluate any unintended consequences that may arise?
    • 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 that you identified in Section 3? Are there additional measures and indicators that you now think should be included?
    • 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?
    • 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:

  • 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 that 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 Action Plan

An organization’s ability to learn, and translate that learning into action rapidly is the ultimate competitive advantage.

—Jack Welch as quoted by Kerrigan

Think back to when you first identified the quality improvement issue for your Course Project. What insights related to quality measurement, improvement strategies, and evaluation have you gained since then? How have these insights informed your view of the issue and shaped your understanding of how to promote positive outcomes for your selected organization? How would you suggest the organization proceed based on the outcomes of your investigation?

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:
    • How would you undertake the process of determining a timeline for planning, implementing, and evaluating this quality improvement plan?
    • 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.

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NURS 6231: Healthcare Systems and Quality Outcomes

NURS 6231 Week 10: Interdisciplinary Collaboration

Perhaps you have heard the story of a U.S. president who toured NASA before the first mission to the moon, and stopped to ask a man what his job was there. The janitor replied that his job was to help put a man on the moon.

Regardless of whether this exchange actually occurred, the story sheds light on an important concept: achieving any great mission requires teamwork and collaboration.

Providing safe, high quality care necessitates that interdisciplinary alliances integrate contributions from many individuals. Take a minute to think about all the people who support or provide care delivery and facilitate the day-to-day operations of a health care organization. Patients and families have direct and indirect contact with a multitude of professionals in any health care setting—from those who clean the floors to those who make the highest-level strategic decisions.

This week, you examine the core competencies that are needed for optimal collaboration, and analyze the value of interdisciplinary teams for reaching quality and safety goals. In addition, you complete your work on the Course Project.

Learning Objectives

Students will:

  • Evaluate interdisciplinary collaboration skills
  • Analyze the benefits of interdisciplinary teams for meeting quality improvement goals
  • Evaluate strategies for developing interprofessional competencies
  • Apply evaluation tools to quality improvement initiatives
  • Analyze the financial implications of quality in health care organizations
  • Synthesize analysis and recommendations into an action plan

NURS 6231: Healthcare Systems and Quality Outcomes

The achievements of an organization are the results of the combined effort of each individual.

—Vince Lombardi

Collaboration is a critical component of quality improvement. It is also a central tenet of your endeavors as a scholar-practitioner in this Walden University Master’s program. To succeed in your role as a nurse leader-manager, it is important to engage in ongoing development of collaborative skills and to help foster a culture that values collaboration.

In Weeks 1 and 2 of this course, you analyzed your strengths and considered how to leverage these strengths for effective leadership. In a similar vein, this week you evaluate your strengths and areas for growth with regard to interdisciplinary collaboration.

To prepare:

  • Review the competencies described in the Interprofessional Education Collaborative report and in Chapter 9 of the Hickey and Brosnan text.
  • As you reflect on the competency statements outlined for each domain, think about which ones reflect your strengths. Which competency statements point to areas for growth?
  • Consider the benefit of working with interdisciplinary teams for addressing quality improvement initiatives.
  • Conduct a search of the literature and select at least one article that illustrates the benefits of interprofessional collaboration for nurse leader-managers as it relates to improving quality.

Note: Think about a potential connection between the concepts presented throughout this course (i.e. systems-level change, quality, etc.), and a Practicum Project that you might focus on in NURS 6600. Consider how you might use interprofessional collaboration in your practicum setting.

By Day 3

Post an analysis of your strengths and areas for growth related to interprofessional collaboration competencies. Explain the benefits of interprofessional collaboration for meeting quality improvement goals. Support your response with examples from current literature.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days suggesting strategies for developing interprofessional competencies. Support your suggestions with evidence from current literature and personal experience.

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NURS 6231: Healthcare Systems and Quality Outcomes

NURS 6231 Week 11: Spreading Innovation

Consider the following innovation in health care delivery:

“AeroClinic is designed to provide a quick, convenient, affordable solution to accessing treatment of common illnesses that require quick attention. It seeks to attract a specific set of patients, including the frequent traveler (who may find it difficult to find time to access these services), airport and airline employees, and government employees who work in the airport.” (AHRQ Healthcare Innovations Exchange, 2012)

As a nurse leader-manager, you are familiar with the many challenges related to cost, quality, and access in health care. As you reflect on the scenario above, what insights arise about why innovative approaches are critical for addressing such challenges?

This week, you examine a variety of innovations and consider how they might be adopted in health care organizations. You also analyze strategies for facilitating communication and engagement that can lead to sustainable innovation in health care.

Learning Objectives

Students will:

  • Analyze health care innovations
  • Evaluate strategies to facilitate sustainable adoption of innovations

An organization may be generally amenable to innovations but not ready or willing to assimilate a particular [Evidence-Based Practice] EBP …If there is tension around specific work or clinical issues and staff perceive that the situation is intolerable, a potential EBP is likely to be assimilated if it can successfully address the issues and thereby reduce the tension.

—Titler, 2010

Adoption of evidence-based innovations in nursing practice is a critical facet of promoting quality and safety. As a nurse leader-manager, you play a pivotal role in evaluating these innovations and promoting those that will positively impact outcomes.

To prepare:

  • Review the information on diffusion of innovation presented in the Learning Resources.
  • Visit the Agency for Healthcare Research and Qualities’ Innovation Exchange website (listed in the Learning Resources). Click on “Innovations & Quality Tools” or “Browse by Subject” then read through a selection of descriptions of innovations.
  • Evaluate how each of these innovations addresses a problem, and determine if you could integrate the innovation (or a similar one) into your organization or one with which you are familiar.
  • Select one of the innovations on which to focus for this Discussion. Think about how you might introduce this innovation in your selected organization, and strategies that you might use to facilitate communication and engagement needed to sustain the innovation.

By Day 3

Post a detailed review of one innovation that you found of particular interest on the AHRQ Innovation Exchange. Explain the problem being addressed, the innovation, and the outcomes and how you might introduce a similar innovation in your organization or one with which you are familiar. Outline strategies you would employ to sustain the innovation.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

  • Ask a probing question, substantiated with additional background information or research.
  • Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
  • Validate an idea with your own experience and additional resources.

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