Quality Improvement Proposal
Improvement is said to be the largest room in the world. The quest for quality is not a spontaneous attempt but includes relentless efforts incorporated with informed decisions and necessary resources input. Quality improvement in healthcare intends to benefit all persons of interest by promoting overall population health, reducing healthcare costs, and improving both provider and patient experience. For this reason, organizations like the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) and the American Nurses Association (ANA) advocate for the establishment of healthcare facilities and availing resources to help identify quality improvement opportunities. Reducing medical errors due to nurse stress and fatigue as a quality improvement opportunity is discussed by considering the problem overview, improvement, steps to implementation, initiative evaluation, and explaining variables, hypotheses, and statistical tests linked to quality improvement.
Problem Overview and Setting
Although preventable, medical errors are reported to escalate at an alarming rate, affecting the entire global healthcare system. Conferring to Ragau et al. (2018), in a recent study by the World Health Organization (WHO), over 40 million medical error occurrences are reported annually. Since I practice at a medical and surgical unit floor, some typical medical errors include hospital-acquired infections, faulty and improper placement of medical devices, medications and anesthesia errors, misdiagnosis, and the disregard of test, to name a few. Agreeably, medical errors, if not promptly addressed, can be the future insurmountable challenge facing the healthcare delivery system.
Medical errors can affect healthcare settings ranging from dispensaries, pharmacies, and medical offices to clinics, surgery centers, nursing homes, and hospitals. Be that as it may, Gejdoš (2015) ‘s findings indicate that these instances invariably affect emergency departments, operating rooms, pediatric diagnosis, intensive care units, and where new procedures are necessary. Further, to impress the urgency of the problem, Samuel (2017) arguably illustrates that medical errors are ranked as the third-leading cause of death in America. All evidence indicates monitoring and responding to medical errors is an urgent call to all healthcare stakeholders. Therefore, this explains why quality improvement with the expectation to mitigate medical errors and provide an enabling environment is utmost.
Need for Quality Improvement and Expected Outcome
The need for quality improvement to eliminate medical errors in my area of practice is inexcusable. As Brazil, Purdy & Bajaj (2019) explain, the elimination of medical errors is crucial to reducing serious patient risks and securing the facility’s reputation. The institution has been facing insurgent numbers of patients preferring our services due to the reported cases of medical errors. Undoubtedly, this has resulted in exponential institutional and government costs. While medical mistakes may have adverse impacts on patients and healthcare facilities, Pomey et al. (2015) further elaborate that providers can develop emotional and mental problems. For example, health professionals manifest a lack of concentration, poor performance, depression, or even suicide. By adhering to the guidelines and protocol of dispensing medications and surgical operations, the facility hopes to improve the overall provider-patient experience. Not only this, but also it helps improve service delivery, which significantly impacts the facility’s reputation. Amenably, previously conducted research has also portrayed support for such improvement initiatives.
The problem at hand poses a significant risk to public health, besides being a leading cause of death globally. Studies by Samuel (2017) discuss the essentiality of mitigating medical errors in the face of the notable effects resulting in premature deaths. Additionally, owing to the advancements in technology and the ever-increasing demand for health and well-being, Gejdoš (2015) encourages nursing educators and learners to understand the need for providing continuous quality improvement. The severity of the problem may not be regarded since many patients are not aware; rather, they are not informed when such mistakes occur. For this reason, Pomey et al. (2015) emphasize the need for patient partnership in eliminating the challenge of medical errors. Taking into account all medical histories, which facilitates the smooth transition between shifts, helps to detect drug-related errors and signs in clinical changes. Medical error reconciliation has been encouraged as countermeasure steps in minimizing, if not alleviating, diagnosis, and treatment errors.
Steps to Implementation
Any quality improvement program or initiative is geared towards organizing and implementing operations meant to assess, monitor, and improve quality healthcare. Dollar et al. (2019) sheds more light on this issue by explaining that all successful quality improvement initiatives should identify the problem, outline its aim, and provide measures to monitor the expected outcome continuously. In this case, the facility in my practice area can consider some effective steps to implementing a quality improvement initiative. On average, quality improvement projects are crucial for any healthcare delivery system. According to Brazil, Purdy & Bajaj (2019), connecting stimulation and quality improvement reduces costly mistakes, enhance customer satisfaction, sell out the facility’s reputation, and promote efficiency through proper time utilization.
When implementing quality improvement programs, the following steps are considered: First, the facility’s management will have to define and map the intended process by listing and prioritizing improvement opportunities. Second, the team needs to identify the requirements for actualizing this program, including eliminating medical errors. The best decisions are influenced by acquiring the appropriate information (Dollar et al., 2019). Therefore, the next step should be gathering and organizing data. Fourth, once sufficient information is obtained, the facility’s team should identify the root cause of the problem, which, in this case, is poor communication and provider stress and fatigue.
The fifth step would include brainstorming to generate potential solutions to the problem. For example, based on Dollar et al. (2019), the facility can improve communication, reduce team member turnover, and evenly distribute errands to avoid overworking its personnel. Finally, in the context of my practicing unit, the facility can incorporate open and honest communication through improved technology, involve the patient in medical errors, and ensure providers have an enabling environment. Forthwith, continued monitoring through evaluation of the initiative should crown the entire process of implementation.
Ways of Evaluating Initiative
Improvement and evaluation processes are two sides of the same coin. Pandhi et al. (2018) argue that both processes help build an inclusive comprehension during assessment processes. As a continuous process, evaluation benefits both the implementers and the target audience. Often, many providers use benchmarking of quality improvement initiatives to determine the extent of such programs. Further, Pandhi et al. (2018) propose using other evaluation methods, such as cause and effect diagrams, force field analysis, and flowcharts to evaluate the success of the initiative. Notably, providers frequently utilize quality measures to improve outcomes. After comparing the overall cost, the period of implementation to effectiveness, and personnel productivity, the initiative could be termed a success. Dramatic improvements were observed, beginning with reduced anesthesia cases, proper prescription, and remarkable growth in the facility overall productivity and performance. Since medical errors are an antagonistic principle to healthcare quality, benchmarking as a continuous evaluation process is requisite. Nonetheless, providers should also consider the identification of variables, hypothesis tests, and statistical tests to prove the initiative’s success.
Variables, Hypothesis Test, and Statistical Test
Ideally, testing for the success of a quality improvement initiative allows organizations to determine whether the opportunity is efficiently utilized and adequate improvement. According to Pandhi et al. (2018), testing the acceptance of the newly introduced practices can help track the improvement process’s success. Further, examining the manner and intensity of the new practice’s effect allows providers to deliver patient-centered care and improve their experience. Therefore, in this case, variables such as age, gender, healthcare cost, socioeconomic and literacy status, ethnicity, and clinical diagnosis. For example, each of these variables, age, and gender, can be utilized to determine which age group and gender are mostly affected by medical errors. Subsequently, both the null and alternative hypotheses are useful only when the expected relationship can be specified; this is, according to Pandhi et al. (2018). For this reason, since the alternative hypothesis explains the relationship between two variables, it stands as the most appropriate hypothesis test to track the quality improvement initiative. Lastly, based on statistical testing, delving into healthcare records and clinical diagnosis would collect accurate and reliable data. Consequently, providing consistent results for evaluating the quality improvement program.
By identifying medical errors as a quality improvement opportunity, this paper has investigated the problem to discuss ways quality improvement initiatives can be successfully implemented. Notably, medical errors were identified as the third-leading cause of death and can affect any healthcare setting. Owing to the reduced number of patients visiting the facility due to a tarnished reputation, the need for improvement was inevitable. Subsequently, the paper also presents the critical steps adhered to during the implementation of quality improvement opportunities. A plan is as good as it is implemented and its effects observed. Ways of evaluating the initiative are discussed, further identifying variables, hypotheses, and statistical tests needed to prove whether the quality improvement program succeeded. Ultimately, the road to evidence-based practice, which begins with understanding the significance of recognizing quality improvement opportunities, ensures providers’ performance and patient satisfaction begins. Although prevention is better than cure, health is underestimated until sickness onset. Opportunity multiplies as it is seized.
Brazil, V., Purdy, E. I., & Bajaj, K. (2019). Connecting simulation and quality improvement: how can healthcare simulation really improve patient care?
Dollar, K. M., Kirchner, J. E., DePhilippis, D., Ritchie, M. J., McGee-Vincent, P., Burden, J. L., & Resnick, S. G. (2019). Steps for implementing measurement-based care: Implementation planning guide development and use in quality improvement. Psychological Services.
Gejdoš, P. (2015). Continuous quality improvement by statistical process control. Procedia Economics and Finance, 34, 565-572.
Pandhi, N., Kraft, S., Berkson, S., Davis, S., Kamnetz, S., Koslov, S., & Caplan, W. (2018). Developing primary care teams prepared to improve quality: a mixed-methods evaluation and lessons learned from implementing a microsystems approach. BMC Health Services Research, 18(1), 847.
Pomey, M. P., Hihat, H., Khalifa, M., Lebel, P., Néron, A., & Dumez, V. (2015). Patient partnership in quality improvement of healthcare services: Patients’ inputs and challenges faced. Patient Experience Journal, 2(1), 29-42.
Ragau, S., Hitchcock, R., Craft, J., & Christensen, M. (2018). Using the HALT model in an exploratory quality improvement initiative to reduce medication errors. British Journal of Nursing, 27(22), 1330-1335.
Samuel, V. K. (2017). Creating a Culture of Mobility: A Quality Improvement Project.