Discussion: Quality Improvement Models Paper

Discussion: Quality Improvement Models Paper

Care quality is a profound concept in the current healthcare systems because it entails the degree to which health services increase the likelihood of desired outcomes, including facilitating recovery and enhancing people’s well-being. According to Nash et al. (2019), it is possible to define care quality using the six dimensions developed by the Institute of Medicine (IOM): care safety, timeliness, effectiveness, efficiency, equity, and patient-centeredness. These dimensions provide healthcare professionals and policymakers with essential guidelines for redesigning healthcare to eliminate harm, reduce delays, curtail costs, incorporate scientific evidence, address health disparities and inequalities, and provide care that respects patient preferences, values, and beliefs. Although the IOM’s care quality domains offer simple rules for redesigning and improving care delivery, adverse events such as medication errors, medical device failures, patient fall, and surgical mistakes require healthcare professionals to implement more contextualized interventions. Therefore, this urge prompts them to rely massively upon quality improvement models that provide comprehensive frameworks for diagnosing issues, implementing evidence-based measures, evaluating progress, and sustaining change by incorporating new approaches into organizational cultures. Consequently, this paper elaborates on the Plan-Do-Study-Act (PDSA) quality improvement model, its components, and how healthcare professionals can use it to address adverse events.

Effects of Adverse Events on Care Quality

Adverse events are unanticipated incidents that can harm patients and lead to multiple ramifications, including deaths, injuries, disability, and compromised quality of life. According to Liukka et al. (2020), approximately one in ten patients is susceptible to such events as medication errors, surgical mistakes, falls, and medical device failures. Therefore, it is possible to contend that patients are the first victims of the consequences of adverse events. In the same breath, health professionals suffer the ramifications of these incidents that manifest through emotional and physical distress. Also, they bear the blame and the burden of potential professional and legal obligations such as license revocation and suspension. Finally, healthcare organizations are the third victims of adverse events and suffer consequences such as reputation, legal, and economic issues (Liukka et al., 2020). Since patients, healthcare professionals, and organizations are susceptible to the consequences of adverse events, they can collaborate to implement quality improvement initiatives. Undoubtedly, an interpersonal collaboration between healthcare professionals, patients, and organizational leaders can thrive in the presence of a profound quality improvement model like the Plan-Do-Study-Act (PDSA) framework.

The Plan-Do-Study-Act (PDSA) Quality Improvement Model

The PDSA model is a cyclic framework developed by Walter A. Shewhart (1891-1967) in the 1920s to provide simple and practical approaches for quality improvement. Chen et al. (2020) contend that Edward E. Deming (1900-1993) further described the PDSA cycle to provide guidelines for quick and efficient piloting of new ideas to achieve incremental progress and facilitate experimental learning. The model’s entry into healthcare emanates from its simplicity, practicality, and ability to reduce administrative workload.

Components of the PDSA Cycle

The PDSA model entails four sequential interrelated steps: Plan, Do, Study, and Act. According to Patricia et al. (2021), the primary objective of the “Plan” phase is to identify change and aspects that form the basis of quality improvement. In the same breath, Nash et al. (2019) argue that the first stage entails additional processes such as understanding the problem and its underlying causes, establishing change objectives, asking questions and making predictions, and planning for the quality improvement project.

In the second phase (DO), the quality improvement stakeholders carry out the plan, document problems, and expected observations, analyze data, and educate and train staff. Also, they pilot the improvement ideas, measure baseline data, and conduct follow-up activities (Chen et al., 2020). During the “study” phase, healthcare organizations can assess the effects of change interventions, determine the level of success, compare results with predictions, summarize lessons, and determine the needed changes consistent with the identified gaps in the plan implementation. Finally, the “Act’ phase entails measures for sustaining change, revising, replicating, or updating the quality improvement project. In this sense, the implementation team can determine whether to repeat the initiative, make necessary changes, identify remaining gaps in the process or performance, and carry out additional PDSA cycles to meet goals and objectives.

How to Use the PDSA Model in Addressing Adverse Events

Although adverse events are unanticipated, they provide opportunities for organizational learning, reflection, benchmarking, and quality improvement. For instance, healthcare professionals can use the PDSA model to create a framework for change and quality improvement. The “Plan” phase enables care professionals to understand the problem, its causes, consequences, and gaps in quality. Also, they can establish consensus objectives, assign responsibilities to Interdisciplinary team members, plan for a quality improvement initiative, and make predictions that form the basis of desired outcomes (Nash et al., 2019). In the second phase (Do), organizational leaders can organize education and training programs for staff members and patients to enhance their awareness of adverse events, prevention, reporting, and response mechanisms. At this point, it is essential to analyze the event’s data, document problems, and unexpected observations, and implement the quality improvement plan.

In the third stage (Study), the implementation team can evaluate and monitor the initiative to establish the discrepancies between the plan and its implementation. Further, it is vital to assess quality improvement indicators, including the rate of event reoccurrence, patients’ and staff members’ opinions and feedback on the initiative, and evaluate the effects of evidence-based practice in addressing adverse events. Finally, the implementation team can determine the trajectory of the plan based on formative and summative evaluations, make necessary changes, identify discrepancies between predictions and actual outcomes, and sustain change by replicating and modifying the plan.

Conclusion

Quality improvement models provide guidelines for understanding clinical problems, developing plans for enhancing care quality, evaluating the progress, and sustaining change. The Plan-Do-Study-Act (PDSA) model is among the frameworks that facilitate change and quality improvement initiatives because it provides 4-step guidelines for planning for change, implementing evidence-based interventions, evaluating the effects of change, and acting on the learned lessons. Consequently, this model can enable healthcare professionals to tackle adverse events by understanding these incidents and their roots causes, setting objectives and consensus goals, carrying out the plan, educating patients, and analyzing data consistent with these events. Also, the model allows them to assess the effects of change, compare results with predictions, determine the change needed to facilitate the plan’s effectiveness, and act on learned lessons to sustain change.

References

Chen, Y., VanderLaan, P. A., & Heher, Y. K. (2020). Using the model for improvement and Plan-Do-Study-Act to effect SMART change and advance quality. Cancer Cytopathology, 129(1). https://doi.org/10.1002/cncy.22319

Liukka, M., Steven, A., Vizcaya Moreno, M. F., Sara-aho, A. M., Khakurel, J., Pearson, P., Turunen, H., & Tella, S. (2020). Action after adverse events in healthcare: An integrative literature review. International Journal of Environmental Research and Public Health, 17(13), 4717. https://doi.org/10.3390/ijerph17134717

Nash, D. B., Joshi, M. S., Ransom, E. R., & Ransom, S. B. (Eds.). (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press

Patricia, K.-M., Victoria, M.-K., Kabwe, C., Micheal, K., Dorothy, C., Martha, M. M., Wahila, R., Petronella, M., & Judith, C. (2020). Implementing evidence-based practice nursing using the PDSA model: Process, lessons, and implications. International Journal of Africa Nursing Sciences, 100261. https://doi.org/10.1016/j.ijans.2020.100261

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Discussion Instructions
Discussion: Quality Improvement Models
What is the best way to implement quality improvement? What particular strategies and/or models should be used when developing a plan? Throughout the past 7 weeks, you have explored quality improvement in healthcare and nursing practice, and you will continue this exploration by analyzing specific quality improvement models. What models might work best in your nursing practice or healthcare organization?
Healthcare is complex and varied; therefore, quality improvement cannot be a one-sized fits all approach. To fit the complex and varied needs of an organization, there are multiple strategies and methods to implement quality improvement.

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For this Discussion, select one quality improvement model to explore and analyze. Using the selected Model, consider how this Model might be implemented in your healthcare organization or nursing practice. Examine the effectiveness of this Model and consider how this Model might be applied to address impacts to adverse events for nursing practice.
To Prepare:
• Review the Learning Resources for this week, and reflect on the different quality improvement models presented.
• Select one quality improvement model from the following to focus on for this Discussion:
o Root Cause Analysis (RCA)
o A3
o Lean
o Plan, Do, Study, Act (PDSA)
• Reflect on the quality improvement model you selected, and consider how it might be implemented in your healthcare organization or nursing practice.
By Day 3 of Week 8
Post a brief explanation of the quality improvement model you selected, including a description of the components that make up this Model. Be specific. Then, explain how this quality improvement model might be implemented in you healthcare organization or nursing practice in response to an adverse event requiring quality improvement. Be specific and provide examples.

Please use headings for each topic: 1. Explanation of Quality Improvement Model 2. Description of the Components that make up this Model, 3. How the Model might be implemented in my healthcare organization (VA). 4. Applying the Model to Address Impacts to Adverse Events for Nursing Practice.

PLEASE USE THE LEARNING RESOURCES PROVIDED TO GUIDE YOUR WRITE-UP AND USE THE REFERENCES PROVIDED FOR THE WRITE-UP:
Nash, D. B., Joshi, M. S., Ransom, E. R., & Ransom, S. B. (Eds.). (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press.
• Chapter 15, “The Role of the National Committee for Quality Assurance” (pp. 389–414)
http://www.ihi.org/resources/Pages/IHIWhitePapers/ComparingLeanandQualityImprovement.aspx

A3 report

http://www.ihi.org/resources/Pages/Tools/Quality-Improvement-Essentials-Toolkit.aspx