Quality Improvement Initiatives
Association of State and Territorial Health Officials. (2014). Quality improvement plan toolkit: Guidance and resources to assist state and territorial health agencies in developing a quality improvement plan. https://www.astho.org/qiplantoolkit.pdf
Knox, L., & Brach, C. (2013). Module 14. Creating quality improvement teams and QI plans. In, Practice facilitation handbook. Agency for Healthcare Research and Quality. https://www.ahrq.gov/ncepcr/tools/pf-handbook/mod14.html
U. S. Department of Health and Human Services Health Resources and Services Administration. (2011). Developing and implementing a QI plan. https://www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/developingqiplan.pdf
To Prepare:
- Review the Learning Resources regarding the implementation of quality improvement initiatives.
- Consider what stakeholders must be present to implement these initiatives and reflect on the leadership strategies needed for success in promoting quality improvement initiatives in healthcare organizations and nursing practice.
- Select a healthcare organization or nursing practice (with which you are familiar) to complete the Organizational Culture Assessment Tool.
The Assignment: (3 pages)
Complete the Organizational Culture Assessment Tool for the healthcare organization or nursing practice you selected. Then, address the following:
- What is the state of cultural/organizational readiness for quality improvement?
- Is the organizational culture present for quality improvement?
- What leadership strategies are present in the organization to support quality improvement, positive patient experiences, and healthcare quality?
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.
Sample Paper
Quality Improvement
Quality improvement initiatives in the acute care setting allow caregivers to meet the clients’ evolving needs. Thus, quality improvement is a continuous process. For the organization to sustain the dynamism necessary for quality improvement, the culture must be receptive to changes. Hence, the cultural assessment tool provides my perception of the acute care setting’s readiness and commitment to quality enhancement.
Organizational Culture Assessment
Key: 1 = Strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, and 5 = strongly agree
| Statement | 1 | 2 | 3 | 4 | 5 |
| I am at ease and comfortable when I’m around others at work – regardless of their title, position, or stature. | ✓ | ||||
| We evaluate the quality of the decisions we make internally. | ✓ | ||||
| Work is shared based not on who “owns it,” but rather on who is in the best position to get it done. | ✓ | ||||
| I can be my whole self while at work and don’t have to pretend to be someone I’m not. | ✓ | ||||
| I am given autonomy in my job. | ✓ | ||||
| We remove ‘silos’ and ‘boundaries’ at work; we aren’t territorial. | ✓ | ||||
| If a process, procedure, approach is not working, we can correct it with ease. | ✓ | ||||
| Everyone here is clear on what drives our success as an organization. | ✓ | ||||
| We use tools and platforms internally to help us collaborate and communicate more effectively. | ✓ | ||||
| The internal tools and technologies we use in my company are as good, if not better than the ones our competitors use. | ✓ | ||||
| We welcome comments from others even if they disagree with us. | ✓ | ||||
| We push past the “we’ve always done it that way” objection. | ✓ | ||||
| We are evaluated on the core values that are important to our success. | ✓ | ||||
| We care about making our community a better place to live. | ✓ | ||||
| I get to exercise my creativity at work. | ✓ | ||||
| People know what other departments need from them and share the right information at the right time. | ✓ |
Cultural/Organization Readiness
The assessment summarizes the cultural and organizational readiness. First, the positive results (scores 4 or 5) relate to nursing satisfaction, teamwork, and commitment to improving the community. The organization has a profound communication system. Caregivers are free to share their ideas, resulting in an expressive professional environment. Effective communication is the foundation for successful teamwork (Rosen et al., 2018). Hence, the acute care nurses utilize their teammates’ suggestions to improve their professional efficacy. Caregivers in the acute care department are also free with each other. There are hardly any instances of incivility, enhancing workplace satisfaction (Nelson et al., 2017). Therefore, the personal comfort that the nurses enjoy enables them to transmit a positive attitude towards patients, enhancing their compassionate and clinical performance. Being free with colleagues and their seniors also makes the nurses more receptive to new ideas. Lastly, the acute care team is committed to improving their patients’ quality of life. They demonstrate their caring attitude by providing sufficient patient education and advocating for improved patient experience. Thus, teamwork, nurse satisfaction, and commitment to community improvement enhance the organization’s readiness for quality improvement.
However, there are some internal challenges. For instance, while communication within the care setting is excellent, interdepartmental information relaying is less efficient. Acute care often deals with the pharmacy, critical care, and hospice care departments. It is hard for acute care nurses to know what these other departments require and vice-versa. Hence, there are delays when conducting interprofessional care or care transitions, jeopardizing the patients’ health and safety (Patel & Landrigan, 2019).
Other shortcomings to the care setting’s readiness include caregiver dormancy and lack of creative expression. Caregivers are often reluctant to change how they work on a large scale. Thus, they are only receptive to minor, case-to-case suggestions. However, they resist drastic, systematic changes, making them unprepared for quality improvement (Li et al., 2019). There is also minimal room for creativity as nurses adhere to strict workplace regulations. Diversion from these guidelines requires approval from senior clinicians, such as the charge nurse or physician, limiting spontaneous creativity. Therefore, a leader seeking to improve the facility’s readiness must address these limitations.
Organizational Culture
One can assess the presence of organizational culture for quality improvement through three metrics: leadership, attitude towards evidence-based practice, and effective communication. The acute care setting has an elaborate leadership structure. At the top are senior clinicians: physicians and nurse practitioners. They guide the rest of the teams in providing medical and nursing care. Charge nurses oversee a smaller group of patients, usually per shift. They make dynamic decisions on various cases while supervising the quality levels that the caregivers embrace.
Meanwhile, the attitude towards evidence-based practice (EBP) is mixed. A positive perception enhances the care setting’s culture, while a negative viewpoint diminishes it. However, the EBP attitude must be collective. The split perceptive means that change agents would have a hard time convincing everyone to engage in quality improvement initiatives.
Lastly, the organization has good intradepartmental communication but poor interdepartmental communication. Since quality improvement initiatives involve different professionals, the organization must enhance its culture to enable facility-wide information transfer. Doing so will elevate the organization’s quality improvement culture (Merlino, 2017). Therefore, while the culture exists, it is not optimal. The clinical leaders and administration members must seek relevant ways to enhance it before implementing major quality-improvement projects.
Leadership Strategies
One leadership strategy that the acute care department utilizes is transformational leadership. The clinical leaders guide their teams toward implementing changes. This approach streamlines care processes, enhancing care quality (Sfantou et al., 2017). Furthermore, it allows the organization to reduce the change-initiated disturbances, meaning that patients do not suffer from communication or clinical mishaps. The facility also uses organizational goals as a leadership strategy. Top-level leaders establish targets and demand that all employees work towards achieving them. Thus, middle-level managers break down the targets into department-relevant goals. For instance, if the overarching aim is reducing readmissions, the acute care manager will focus on proper diagnosis, patient education, etc. Thus, the strategy orients the entire workforce towards a common purpose, enhancing patient outcomes.
Conclusion
The acute care department is vital to the organization since it has the most inpatients. The organizational culture assessment portrays the organization’s readiness for quality improvement. It also highlights the individual cultural elements and how they would impact systematic quality-improvement initiatives. Lastly, the evaluation expounds on the leadership strategies, demonstrating their significance to quality enhancement. Hence, while not devastating, the acute care department’s culture requires some enhancement to facilitate better patient outcomes and experiences.
References
Li, S., Cao, M., & Zhu, X. (2019). Evidence-Based Practice: Knowledge, Attitudes, Implementation, Facilitators, and Barriers among Community Nurses—Systematic Review. Medicine, 98(39). DOI: 10.1097/MD.0000000000017209
Merlino, J. (2017, Nov. 06). Communication: A Critical Healthcare Competency. https://www.psqh.com/analysis/communication-critical-healthcare-competency/
Nelson, J., Nichols, T., & Wahl, J. (2017). The Cascading Effect of Civility on Outcomes of Clarity, Job Satisfaction and Caring for Patients. Interdisciplinary Journal of Partnership Studies, 4(2). https://doi.org/10.24926/ijps.v4i2.164
Patel, S. J., & Landrigan, C. P. (2019). Communication at Transitions of Care. Pediatric Clinics of North America, 66(4), 751–773. https://doi.org/10.1016/j.pcl.2019.03.004
Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in Healthcare: Key Discoveries Enabling Safer, High-quality Care. The American psychologist, 73(4), 433–450. https://doi.org/10.1037/amp0000298
Sfantou, D. F., Laliotis, A., Patelarou, A. E., Sifaki-Pistolla, D., Matalliotakis, M., & Patelarou, E. (2017). Importance of Leadership Style towards Quality-of-Care Measures in Healthcare Settings: A Systematic Review. Healthcare, 5(4), 73. https://doi.org/10.3390/healthcare5040073
