Running head: DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 1

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DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 2

Data Analysis and Quality Improvement Initiative Proposal Introduction

There is a constant pursuit for improvement in the quality of care among hospitals across

the world. Improving the quality of care increases the positive health outcomes among patients,

leads to a better working environment, and also raises the reputation of the hospitals as more

people seek their services. However, the improvement in quality can only be realized through

efficient quality improvement innovations, support from the administration and the medical staff,

evidence-based practices, continuous learning, the working together of different healthcare

stakeholders, and effective communication. Nurses play a great role in contributing to quality improvement initiatives in healthcare

organizations. They are involved in frequent interactions with the patients and this makes them

important in every effort to improve the quality of care. The dashboard metrics from a healthcare

organization can help to identify the different problems in a healthcare institution and can be the

foundation of quality improvement initiatives. The aim of quality improvement is to improve on

the weaknesses in the hospital to ensure a high-quality care to all the patients. The Vila Health

dashboard provides the hospice information for the year 2014 and 2015. The information

includes both near misses and events that resulted in potential harm to the patients. The quality

indicators used in the report are the length of stay, inpatient unit, pain, and symptom. Analysis if the dashboard metrics

Patients in hospice care require a lot of attention from the physicians and nurses in a

healthcare facility. The level of care offered to patients in hospice care determines the level of

quality offered at the hospital. It shows how the hospital takes care of its most vulnerable patients

and this can be used as a benchmark on whether the hospital upholds the highest quality

standards. Interdisciplinary professionals such as nurses, dieticians, ancillary medical staff,

pharmacists, physicians, and therapists attend to the patients in hospice care. They all work

together to ensure the safety and comfort of these patients.

DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 3

Table 1

Hospice Unit-Year LOS IPU Pain level Symptom 2014 50 47 13 13 2015 46 27 17 22

The data from the hospice care revealed that the length of stay decreased from 50 to 46

days and the IPU number also decreased from 47 to 27. On the contrary, there was an increase

the number of patients with a high pain level from 13 in the year 2014 to 17 in the year 2015 and

the symptoms also increased from 13 in 2014 to 22 in the year 2015. Inasmuch as some of the quality indicators showed an improvement, the increase in the

patients experiencing high pain and symptoms is not a good indication of the quality of care at

the hospital. High-quality care should be effective, safe, reliable, patient-centered, equitable, and

efficient (Sfantou et al., 2017). The poor management of pain in hospice care lowers the quality

of life for the patients (Cea et al., 2016). The assessment and management of pain in hospice care

have a direct effect on the quality of care for the patients. The reduction in the length of stay is

not significant enough to portray quality improvement at the hospital. The length of stay in the

hospital influences the rate of readmission. A long length of stay at the hospital is associated with

high rates of readmission (Sud et al., 2017). Therefore, hospitals should strive to lower the length

of stay of patients to improve the quality of care. The rate of readmission as a result of staying

long at the hospital has a high cost on both the patients and the hospital. In the United States,

hospitals readmit approximately 20% of Medicare patients within 30 days after discharge and

this leads to an annual cost of $17 billion (Sud et al., 2017). The readmissions also show that

there is a low quality of care at the hospital and this is a bad reputation that most hospitals would

like to avoid. The information about the length of stay, pain level, and symptoms portray a deficiency

in the quality of care and this can have negative implications on the healthcare stakeholders.

DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 4

They lower the satisfaction of the patients with the quality of care, and this limits the number of

patients that the hospital attends to due to the lost confidence in the capabilities of the hospital

and its staff. The reduction in the number of patients has an effect on the hospital revenue and

also lowers the reimbursement from insurance companies and this can lower the motivation of

the staff which further affects the quality of care negatively. The length of stay, symptoms, and

pain level indicate the need for quality improvement. Quality Initiative Proposal

Efficient nursing leadership is important in improving the quality of care for patients in

every healthcare setting. Effective leadership is essential to improving the quality of care in

healthcare organizations (Sfantou et al., 2017). Therefore, a change in leadership will help in

enhancing the quality of care in the healthcare facility. The repercussions on hospitals in case of

readmission, which increases with the length of stay, encourage hospitals to lower the length of

stay for patients and improve other quality measures such as the pain level and symptoms for the

hospice care patients. In the year 2012, the Centers for Medicare and Medicaid Services (CMS)

instigated the Hospital Readmission Reduction Program (HRRP). The HRRP allows Medicare

and Medicaid Services to lower the payments to hospitals that have high rates of readmission

within 30 days after a patient is discharged (Khouri et al., 2017). Therefore, every hospital must

strive to improve the quality of care offered to its patients. The existing quality improvement initiatives are ineffective. The leadership style does not

motivate the nursing staff enough to ensure they contribute to improving the quality of care for

the hospice patients. Effective leadership should motivate the healthcare staff and lead to visible

improvements within the care facilities. The lack of any significant improvement after a whole

year shows the level of incompetence in the leadership. It portrays a lack of commitment,

dedication, leading by example, and encouraging the nurses to become better through motivating

them and providing an environment for their development.

DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 5

The leadership style can be changed to ensure an improvement in quality. The patient

outcome can be improved by encouraging healthcare staff such as nurses in the hospice care unit

to acquire more skills through different learning methods or working closely with the

experienced nurses in the facility. The motivation of nurses will help them to feel like part of the

organization and will improve their productivity. Leadership determines the level of trust that

healthcare staff has with the healthcare facility. Good leadership results in the development and

strengthening of trust and this promotes the productivity of the nursing staff. Therefore, a change

in the style of leadership will result in positive improvements that further lower the length of

stay, the symptoms, and the number of patients who experience high levels of pain. Changing

from the current leadership style to transformational leadership will help to improve the health

outcomes. Transformational leadership is portrayed by motivating the staff and developing good

relationships with them. Transformational leaders inspire staff respect, confidence and

communicate loyalty through their shared vision which leads to improved productivity, job

satisfaction, and the strengthening of employee morale (Sfantou et al., 2017). Transformational

leadership in the organization will help to improve the productivity of the nurses, enhance their

job satisfaction, and improve their morale leading to better health outcomes for the hospice

patients. The Model for Improvement can be used as an evidence-based strategy for improving the

quality of hospice care. The strategy offers a way to structure the improvement projects and it

contains two distinct parts. The first section has three questions that ask what is to be

accomplished, how to determine if there is an improvement and the changes that will result in the

improvement. The hospital aims to accomplish better quality of care for the hospice patients. It

will know if there are improvements based on the number of patients who experience the

different measures of quality. For example, a significant decline in the number of patients who

DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 6

stay long at the hospital or experience great pain will indicate an improvement. The necessary

change to achieve improvement in quality is the transformational leadership style. The Model for

Improvement has a Plan-Do-Study-Act (PDSA) cycle that will also help to implement the

changes at the hospital. The stages of the PDSA cycle include planning, doing, studying, and

acting. Plan: This is the initial stage and includes planning for the test. The hospital can plan for

this change by identifying methods of collecting data during the test to know if they are

making changes. They can also plan the section of the hospice care to use for the initial

test. Do: It involves trying out the test on a small scale. The hospital can use a small section of

the hospice care or a sample of patients to test the effect of the change in leadership style. Study: It involves comparing band analyzing the data collected before the study and after

implementing the change. It helps to understand the effectiveness of the change and

whether it is worth implementing. Act: At this stage, the change is refined based on the discovery from the comparisons and

analysis of data. Quality indicators approved by the Agency of Healthcare Research and Quality include

mortality, utilization, and volume indicators. Therefore, the changes in the volume of patients can

help in determining the level of the quality of care in a hospital. The interprofessional team can

meet the challenge of not understanding the full scope of the problem since only four quality

indicators are used in the experiment. They should use the other indicators set by the benchmark

such as mortality and utilization indicators to understand the extent of the problem. The available

information also shows only the problem existing in the hospice care and no other areas within

the facility. This limits the implementation of the change to the hospice care unit only yet the

problem could be emanating from a different department in the hospital. Including information

DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 7

from other departments in the hospital and testing the change in leadership on them too can help

to improve the situation in the whole hospital. Integrate Interprofessional Perspectives to Lead Quality Improvements

Interprofessional perspectives can help in improving the quality of care. The

professionals are gifted in different areas and they can combine their knowledge and skills in

specific areas to improve the quality of care in healthcare organizations. Interprofessional

collaboration is the ability of every healthcare professional to embrace the complementary

responsibilities in a team, share problem-solving responsibilities, work cooperatively, and make

decisions that contribute to efficient patient care (Busari, Moll, & Duits, 2017). The nurses and

physicians will have to work collaboratively to improve the quality of care. I will ensure the

roles are fully engaged by ensuring that there are professionals assigned to every part of

improving the quality of care. There will be people responsible for every quality indicator from

the provided data. The initiative will incorporate the concept of interpersonal relationships. It

will help in improving the relationship between the team members and lead to better outcomes.

The outcomes to measure the effect of the intervention will help the interprofessional team to

understand whether they succeeded in developing a good team that can improve care or not. It

will provide guidance on what they should improve on and what they are doing best and should

maintain. The proposed initiative will improve the work-life quality of the staff and the

interprofessional team through collegial relationships. Collegial relationships between healthcare

professionals improve their work-life quality and promote job satisfaction (Nowrouzi et al.,

2016). It will empower the nurses and members of the interprofessional team leading to better

work-life quality. Effective Communication Strategies to Promote Quality Improvement

Effective communication is essential for the success of the interprofessional team. The

Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) can help in

DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 8

improving communication among the members of the interprofessional team. The tools provided

by the strategy give an evidence-based framework that enhances communication in teams. The

strategy eliminates subjectivity and emotional charge to allow team members to work together

effectively (Keller et al., 2013). This provides a good environment for communication and

increases confidence and competence when responding to and resolving conflicts. The proposal

will also include the SBAR communication model. The model is effective in effective

assessment of situations. It looks into the situation and background before making an assessment

and recommendations. This helps to provide a better perspective when solving problems because

of the vast information acquired using the communication model. Conclusion

It is essential for healthcare facilities to continuously improve their quality to ensure

better care for the patients. An interprofessional team can work together to improve the quality of

care and lower the number of patients who experience excessive pain and also decrease the

length of stay in the hospital, leading to lower readmission rates. Improving the quality of care

will result in better outcomes for all stakeholders. Using the PDSA cycle, strategies such as

TeamSTEPPS, and the SBAR communication model will enhance the interaction and efficiency

of the interprofessional team leading to quality improvement and better health outcomes.

DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 9

References Busari, J. O., Moll, F. M., & Duits, A. J. (2017). Understanding the impact of interprofessional

collaboration on the quality of care: a case report from a small-scale resource limited

health care environment. Journal of Multidisciplinary Healthcare, 10, 227. doi:

[10.2147/JMDH.S140042] Cea, M. E., Reid, M. C., Inturrisi, C., Witkin, L. R., Prigerson, H. G., & Bao, Y. (2016). Pain

assessment, management, and control among patients 65 years or older receiving hospice

care in the US. Journal of Pain and Symptom Management, 52(5), 663-672. doi:

[10.1016/j.jpainsymman.2016.05.020] Keller, K. B., Eggenberger, T. L., Belkowitz, J., Sarsekeyeva, M., & Zito, A. R. (2013).

Implementing successful interprofessional communication opportunities in health care

education: a qualitative analysis. International Journal of Medical Education, 4, 253. doi:

[10.5116/ijme.5290.bca6] Khouri, R. K., Hou, H., Dhir, A., Andino, J. J., Dupree, J. M., Miller, D. C., & Ellimoottil, C.

(2017). What is the impact of a clinically related readmission measure on the assessment

of hospital performance? BMC Health Services Research, 17(1), 781. doi:

[10.1186/s12913-017-2742-x] Nowrouzi, B., Giddens, E., Gohar, B., Schoenenberger, S., Bautista, M. C., & Casole, J. (2016).

The quality of work life of registered nurses in Canada and the United States: a

comprehensive literature review. International Journal of Occupational and

Environmental Health, 22(4), 341-358. doi: [10.1080/10773525.2016.1241920] Sfantou, D. F., Laliotis, A., Patelarou, A. E., Sifaki-Pistolla, D., Matalliotakis, M., & Patelarou,

E. (2017, October). Importance of leadership style towards quality of care measures in

healthcare settings: a systematic review. Healthcare 5(4), 73. doi:

[10.3390/healthcare5040073] Sud, M., Yu, B., Wijeysundera, H. C., Austin, P. C., Ko, D. T., Braga, J., … & Lee, D. S. (2017).

Associations between short or long length of stay and 30-day readmission and mortality

DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 10

in hospitalized patients with heart failure. JACC: Heart Failure, 5(8), 578-588.

https://doi.org/10.1016/j.jchf.2017.03.012

Running head: QUALITY IMPROVEMENT INITIATIVE PROPOSAL 1

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Data Analysis and Quality Improvement Initiative Proposal

Learner’s Name

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Quality Improvement for Interprofessional Care

Data Analysis and Quality Improvement Initiative Proposal

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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

th