Quality and Sustainability Paper: Part 2

Quality and Sustainability Paper: Part 2

Quality improvement initiatives depend on quality institutional assessment, data generation and analysis, and the development of evidence-based interventions to manage current problems or improve contemporary interventions. The sustainability of any project refers to its ability to withstand the test of time and persist based on its appropriateness, cost-effectiveness, and efficacy. Healthcare programs target specific care interventions to ensure quality outcomes. Education programs, especially for care providers, assess the efficiency of current interventions, determine gaps and areas of improvement, and use evidence-based strategies to implement change in these areas. Facilities then create a workable plan and framework to implement change in their institutions. This paper focuses on quality and safety improvement implementation at a dialysis center.

Quality and Sustainability Paper Part 1 Synthesis

DaVita Kidney Care Center is a facility that specializes in dialysis and is committed to quality and safe care delivery. The problem of interest is patient cannulation. Patients in dialysis are cannulated to create an entry point for the dialysis tubes. The access points are in major blood vessels and are left intact for consecutive use. These cannulas have large bores, which leave some open wounds and thus increase the need for vigilance in their insertion to ensure a high success rate. Canulation sites are also prone to infections, especially if the staff does not implement sepsis prevention interventions. The facility has a program that requires canulation teams to focus only on canulation procedures, monitoring their outcomes, and educating nurses on effective canulation methods. The program has successfully monitored and ensured success in cannulation procedures, patient satisfaction, and reducing complications such as infections. Evaluation and improvement of the facility’s patient cannulation program can lead to better outcomes.

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Current Evidence-Based Quality or Safety Program Designs

Various evidence-based strategies for quality and safety program designs aim to ensure safety and quality care delivery in dialysis, especially in cannulation procedures. The program designs are influenced by institutions such as the joint commission, Agency for Healthcare Quality and Research, the World Health Organization, and the Center for Disease Control and Prevention. These program designs implement measures in either or all of the following areas: staff education, policy development, patient education, and environmental modifications to ensure safety in patient cannulation procedures. The evidence-based programs implemented in facilities include clinician education program design, auditing tools and checklists systems designs, and patient and family education program designs.

The clinician education program design is founded on the recommendations of the CDC. The program focuses on extensive staff education on procedures and aseptic techniques in various catheter sites in dialysis. The specific competencies emphasized ensure extensive skills in procedure performance and asepsis, hence the significance of clinician education programs. According to the CDC, staff education focuses on core interventions such as “surveillance and feedback, hand hygiene, catheter access care, catheter reduction, patient engagement, skincare, and catheter disinfection.” The program emphasizes the demonstration of staff competency in performing these procedures and caring for these sites. Clinician education calls for nurses’ extensive education to ensure safe cannula/catheter insertion and care of the insertion sites.

Patient education programs are founded on the AHRQ, CDC, and WHO recommendations on family and patient engagement in care delivery. Yang et al. (2021) note that the patients in their homes cause a significant percentage of catheter insertion/cannulation site infections, hence the significance of the education program designs focusing on patient education. Patient education increases participation in care interventions and is associated with quality and safe patient outcomes. Kokorelias et al. (2019) note that patient and family education is the basis of successful family-centered care because patients and families involved in care delivery processes report more satisfaction and better quality and safety outcomes. According to the CDC (n.d.), education in patients undergoing hemodialysis includes hand hygiene, cough etiquette, general access care at home, infections signs and symptoms, emergency problems care, catheter risks, and basic infection control practices.” Checklists for effective education can be used to inform the education process and ensure it is effective, given its great significance.

Auditing tools and checklists are used alongside other programs to ensure all safety procedures and resources are followed and availed before implementing interventions. According to the CDC (n.d.), audit tools and safety checklists are used by institutions to assess staff practices to ensure they implement the recommended interventions in the facility. The checklists are short reminders to staff and help ensure all procedures and infection prevention measures are followed to ensure patient safety and quality care delivery (CDC, n.d.). The most crucial safety purpose of such programs is that patients and families employ infection prevention interventions, reducing the safety issues associated with cannulation.

Proposed Evidence-Based Change

The proposed program is Clinician and Patient Canulation Education Safety Program, emphasizing clinician and patient education to produce safe and quality patient outcomes. The program will integrate patient and clinician education aspects and auditing and checklist systems to improve outcomes. Patient education will ensure that patients and their families participate in care and implement safety interventions hence quality outcomes (Yang et al., 2021). The facility will develop education programs for staff and patients, emphasizing the necessary competencies to ensure collaborative efforts in providing quality and safety in canulation procedures. The program will significantly improve the previous Patient Canulation Program because it will also incorporate aspects of staff assessment and patient education. Staff assessment increases their vigilance and desire to implement interventions according to the organizational policies and national guidelines.

The education program will focus on all staff in the facility to ensure every staff has adequate skills and knowledge, hence the gradual elimination of the team responsible for the cannulations. The program will ensure that all staff are competent enough to perform these procedures in and out of the facility and can respond to emergencies, hence care continuity and patient safety at all times (Yang et al., 2021). Staff and patient education will be based on organizational checklists to ensure all quality and safety aspects are considered in the various interventions in the program. The checklists are a vital modification and will provide evidence that procedures and education components are followed. In this program, data on the success of canulation procedures and the outcomes, including infections, will also be collected from program analysis and organizational safety and quality metrics measurement. Milson et al. (2020) note that integrated interventions focusing on patients and care providers produce better quality and safety outcomes.

Potential Obstacles to EBP

EBP and change implementation are not always smooth journeys, and they face barriers stemming from such factors as change resistance, scarcity of resources to implement the change, among others. According to Alatawi et al. (2020), the most significant barriers to EBP implementation in nursing are change resistance, lack of EBP knowledge, economic barriers, and managerial support. The economic changes associated with the change are manageable. Hence, the barriers to this program are change resistance, lack of EBP knowledge, autonomy, and corresponding physician support. Nursing is hardly autonomous, and the lack of physicians and other professionals, such as nephrologists, support in proposing and implementing change affects EBP success. Engaging nursing leadership help promote the project implementation success (Alatawi et al., 2021). Leaders in nursing are vital in influencing the executive leadership through advocacy strategies to implement change that improves quality and safety outcomes in healthcare facilities.

Alqahtani et al. (2022) note that the education levels of EBP proponents influence EBP acceptance or resistance. Leveraging advanced practice registered nurses in the facilities and the power of evidence from the research will help show the current shortfalls and need for change and increase acceptance of the EBP. Lack of knowledge about an EBP/program is a significant barrier to its implementation. The program is complex and contains multi-step processes, and a lack of knowledge about it may hinder its implementation due to stakeholders’ resistance. Investing in extensive stakeholder education on the program is necessary for its implementation. Nielson et al. (2021) state that the quality of employee preparation determines their confidence in the change’s efficacy and ability to implement it. Thus, extensive staff education on the program and allowing them adequate time to understand the project will play a huge role in promoting their buy-in and eliminating barriers to change/change resistance. The potential barriers discussed above can be adequately managed in the facility to promote quality and safe care using the evidence-based strategies discussed.

Stakeholders within the Healthcare Entity

The most significant stakeholders of this project are care providers, patients, and institutional leadership. The groups of great significance are the executive leadership and the care provider team. The care provider team will be responsible for implementing some interventions, such as utilizing checklists in procedures and patient education. They will also evaluate the program and provide vital feedback for the project’s implementation. According to Dineen-Griffin et al. (2019), healthcare providers play vital roles in patient advocacy, ensuring that proposed changes present no harm to patients and ensure quality care delivery. They should ensure that most strategies are patient-centered and focus on patient empowerment through involvement and access to healthcare information (Dineen-Griffin et al., 2019).

The organization leadership group is crucial and will determine the project’s implementation. They will provide vital feedback and suggest necessary improvements to the program. They will also avail resources (fiscal, human, and monetary) necessary to implement the change (Muhammed & Zaim, 2020). Their roles will also include preparing training schedules, auditing tools, and checklists based on available guidelines to facilitate the desired change. They will also implement interventions for staff assessment using the tools and checklists in assessing staff assessment. Muhammed and Zaim(2020) note that one of the overarching roles of healthcare leadership in a project’s implementation process is to oversee project activities, foster teamwork, and offer social and managerial support. Thus, leadership teams are vital stakeholders who play crucial roles in project implementation and influencing project success.

Patients are also vital stakeholders; their feedback will inform the implementation process. Their understanding of the project will enhance their cooperation. Their roles will include implementing taught interventions and reporting their efficacy to the healthcare providers. They will also collaborate with care providers throughout the implementation processes through information and feedback. Pereno and Eriksson (2020 note that besides determining the vital stakeholders, healthcare professionals should ensure knowledge of innovation and promote communication and collaboration among its stakeholders.


Change Management Theory

Kurt Lewin’s change theory is the most applicable in implementing the proposed change in the facility. The change theory is one of the most widely used theories to guide nurses, and other healthcare providers are they propel change in healthcare facilities. The theory has three stages that guide the development of the various interventions, reduce change resistance, influence stakeholder buy-in, and embed the change in the organizational culture (Memon 2021). Memon (2021) shows that the theory significantly influences employee engagement (besides knowledge) in change interventions. Muldoon (2020) notes that Kurt Lewin’s theory focuses on social motivation, like professor Elton Mayo, and the impact of staff motivation on project success.

The theory’s first stage emphasizes establishing a problem by evaluating the current performance and convincing stakeholders why change is necessary. The information includes healthcare performance data and quality and safety indicators such as successful versus unsuccessful cannulation and patient satisfaction. AbuTahoun and Khan (2019) note that Kurt Lewin’s theory is one of the success factors as it ensures project success ad minimizes resistance to change. The second stage entails facilitating change through interventions such as availing resources and incentives to encourage staff to implement the necessary change. The last stage, refreezing, focuses on ensuring the changes made are embedded in the organizational culture through policies and guidelines developments. The theory influences fiscal changes in the organization, ensuring the permanency of the change, unlike other change theories (AbuTahoun & Khan, 2019). Thus, the theory will help enhance change, motivate staff, facilitate change, and enhance its embedment in the organizational culture, hence the change’s permanency. Thus, it is the best change theory to oversee the quality and safety program’s implementation.

Expected outcomes

Developing this program aims to promote quality and safety in processes surrounding cannulations in dialysis and promote overall patient health. One of the program’s expected outcomes is decreased infections and other complications associated with cannulation (including catheter insertion procedures). Education increases personal and professional knowledge, skills, confidence, and responsibility, thus ensuring increased vigilance in activities and minimized errors (Bhat et al., 2021). Bhat et al. (2021) show that healthcare providers’ confidence in care delivery and job satisfaction is directly related to the extent of the training they received. By enhancing the knowledge of staff, the expected outcomes in this project are an increased number of successful cannulations (evidence of competencies growth) and a higher ratio of successful to unsuccessful cannulation, high staff job satisfaction scores and self-reported competencies and skills, and an improved perception towards patient safety and quality care in canulation procedures.

Another expected outcome is improved patient satisfaction scores and self-reported health experiences. Zhang and Xu (2021) show that patient education increases self-care ability, quality of life, confidence in healthcare workers, and patient satisfaction, leading to better patient outcomes. Educated patients often have better health outcomes and improved patient satisfaction, which is one of the AHRQ’s quality care and patient safety indicators. The proposed change in the organizational program will thus create significant change in the healthcare facility on staff, patients, and patient outcomes, hence its significance.


Quality improvement at DaVina Kidney Care Center will focus on improving the current Patient cannulation program. The focus is to ensure the efficacy of care, quality outcomes, and patient safety. The intention is to ensure the program changes are comprehensive, encompass all patient care aspects, and are embedded in the organizational culture. The new program will improve the previous program and emphasize patient and staff education and evaluation of the education and procedures using auditing tools and checklists. The projected outcomes are improved staff knowledge and subsequent success in procedures, confidence, and job satisfaction among staff. Among patients, projected outcomes are satisfaction with care interventions, better healthcare experiences, and decreased complications (infections) of canulation procedures. Expected obstacles such as change resistance and lack of nursing autonomy will be managed using strategies such as stakeholder communication and leveraging APRNs and organizational leadership support.


AbuTahoun, T. N., & Khan, N. (2019). The management role in promoting individual readiness for change. In International Conference on Management and Information Systems (Vol. 29, pp. 217-22).

Alatawi, M., Aljuhani, E., Alsufiany, F., Aleid, K., Rawah, R., Aljanabi, S., & Banakhar, M. (2020). Barriers of implementing evidence-based practice in the nursing profession: A literature review. American Journal of Nursing Science, 9(1), 35-42. https://doi.org/10.11648/j.ajns.20200901.16

Alqahtani, J. M., Carsula, R. P., Alharbi, H. A., Alyousef, S. M., Baker, O. G., & Tumala, R. B. (2022). Barriers to implementing evidence-based practice among primary healthcare nurses in Saudi Arabia: A cross-sectional Study. Nursing Reports, 12(2), 313-323. https://doi.org/10.3390/nursrep12020031

Bhatt, N. R., Davis, N. F., Thorman, H., Brierly, R., & Scopes, J. (2021). Knowledge, skills, and confidence among healthcare staff in urinary catheterization. Canadian Urological Association Journal15(9), E488. https://doi.org/10.5489/cuaj.6986

Center for Disease Control and Prevention (CDC, n.d.). Dialysis Safety. Retrieved 26th January 2023, from, https://www.cdc.gov/dialysis/index.html

Dineen-Griffin, S., Garcia-Cardenas, V., Williams, K., & Benrimoj, S. I. (2019). Helping patients help themselves: a systematic review of self-management support strategies in primary health care practice. PloS One14(8), e0220116. https://doi.org/10.1371/journal.pone.0220116

Kokorelias, K. M., Gignac, M. A., Naglie, G., & Cameron, J. I. (2019). Towards a universal model of family-centered care: a scoping review. BMC Health Services Research19, 1-11. https://doi.org/10.1186/s12913-019-4394-5

Memon, F. A. (2021). Improving Employee’s Engagement in Change: Reassessing Kurt Lewin’s Model. City University Research Journal11(1).

Millson, T., Hackbarth, D., & Bernard, H. L. (2019). A demonstration project on the impact of safety culture on infection control practices in hemodialysis. American journal of infection control47(9), 1122-1129. https://doi.org/10.1016/j.ajic.2019.02.026

Muhammed, S., & Zaim, H. (2020). Peer knowledge sharing and organizational performance: the role of leadership support and knowledge management success. Journal of Knowledge Management24(10), 2455-2489. https://doi.org/10.1108/JKM-03-2020-0227

Muldoon, J. (2020). Kurt Lewin: Organizational Change. The Palgrave Handbook of Management History, 615-632. https://doi.org/10.1007/978-3-319-62114-2_32

Nielsen, K., Dawson, J., Hasson, H., & Schwarz, U. V. T. (2021). What about me? The impact of employee change agents’ person-role fit on their job satisfaction during organizational change. Work & Stress35(1), 57-73. https://doi.org/10.1080/02678373.2020.1730481

Pereno, A., & Eriksson, D. (2020). A multi-stakeholder perspective on sustainable healthcare: From 2030 onwards. Futures, 122, 102605. https://doi.org/10.1016/j.futures.2020.102605

Yang, Z., Ma, X., Chen, Y., Cao, Y., Li, Q., Pan, X., & Wang, L. (2021). Effects of a quality improvement program to reduce central venous catheter-related infections in hemodialysis patients. The American Journal Of The Medical Sciences361(4), 461-468. https://doi.org/10.1016/j.amjms.2020.10.018

Zhang, X., & Xu, C. (2021). Research Progress on Self-Care Ability of Hemodialysis Patients. Open Journal of Nursing11(5), 320-330. https://doi.org/10.4236/ojn.2021.115029



Please see the attached Quality

and Sustainability Paper PART 1 for use to continue this assignment which is

Part 2.

Quality and Sustainability Paper: Part 2

This assignment aims to determine what is needed to promote successful implementation and sustainability of a quality or safety program for your selected health care entity/issue.

General Guidelines:

Use the following information to ensure the successful completion of the assignment:

This assignment uses a rubric. Please review the rubric before beginning the assignment to become familiar with the expectations for successful completion.
Doctoral learners are required to use the APA style for their writing assignments.
This assignment requires that you support your position by referencing six to eight scholarly resources. At least three of your supporting references must be from scholarly sources other than the assigned readings.

Write a paper (2,000-2,500 words) that provides the following:

Incorporate all necessary revisions and corrections suggested by your instructor for Part 1. Synthesize the different elements of Part 1 and Part 2 into one paper using transitions to connect ideas and concepts.
Evaluate current evidenced-based quality and/or safety program designs that can be implemented to improve the quality and/or safety outcomes for your selected quality and/safety issue at your identified health care entity. Based on this evaluation, propose an evidence-based quality and/or safety program to address your selected issue from Part 1. Explain how your proposed design will better improve the outcomes for the selected quality and/or safety issue as compared to the program currently in place at the health care entity.
Identify potential obstacles (such as economics or ethical issues) that may hinder the implementation of the proposed quality and/or safety program and suggest ways to overcome these.
Identify stakeholders within the selected health care entity with whom you may need to collaborate and discuss the role of each stakeholder in the implementation of the proposed program. In the identification of stakeholders, also include specific groups and leaders that are needed.
Identify a change management theory you will use to support the implementation of your quality and/or safety program. Provide evidence that supports the use of this theory within the program you designed.
Discuss the expected outcomes of the implementation of your proposed quality and/or safety program and ways to ensure sustainability of the expected outcomes.



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