Continuous quality improvement is an extremely important aspect of the everyday life of any contemporary healthcare organization. Since healthcare is one of the most dynamically developing spheres, growth, change, and the ability to transform in order to follow the latest standards and best practices are the major tasks of the organizations willing to compete at a high level of their industry. Palmetto hospital is known for its numerous quality improvement initiatives some of which have become the winners of different quality achievement awards.
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One of the continuous quality initiatives at Palmetto hospital is focused on the improvement of staffing and employee retention. Many researchers connected the rates of nursing staffing in a healthcare organization and patient safety and outcomes (Henriksen, Battles, & Marks, 2015; Hughes, 2008; Rapin, D’Amour, & Dubois, 2015). In particular, the initiative carried out at Palmetto hospital is aimed at the provision of sufficient staffing in acute care where understaffing correlates with the prevalence of hospital-acquired pressure ulcers and patient falls (Moates, 2014).
Root cause analysis of the initiative showed that the hospital has been experiencing the adverse effects of nursing understaffing which resulted in a number of outcomes such as the excessive workloads for nurses, a growing rate of turnover intention among the overworked staff members, patient falls, an increased rate of hospital-acquired pressure ulcers, and a disrupted workflow due to the engagement of the staff members with lower qualification and the need for the existing qualified nurses to cover multiple tasks simultaneously.
In addition, the failure mode effects analysis of the problem showed that the effects of failures caused by the insufficient number of nurses employed in different units were of moderate and high severity. In particular, each of the effects (in an implicit or explicit manner) translated into the patient outcomes, satisfaction, and quality of care. Moreover, some effects also produced a negative impact on the nursing staff members and thus worked in a cyclical fashion creating a sequence of events and outcomes that repeat. In addition, since Palmetto hospital actively practices interprofessional collaboration and cross-disciplinary approaches to clinical and organizational issues, the insufficiency of the nursing staff caused complications for the other collaborating professionals and, in some cases, resulted in the inequitable workloads and tasks allocation for the other practitioner involved. In other words, it is possible to notice, that the problem of staffing faced by the hospital is complex and has many layers, thus affecting a wide range of aspects of the organizational and staff performance on several levels.
Moreover, the increased rate of hospital-acquired pressure ulcer occurrence and patient falls can be recognized as serious safety issues. In response to the emerged problems, the managers of several units, including acute care, held meetings and introduced a series of measures aimed at the elimination of the problem. Due to the insufficiency of the nursing staff, some of the tasks involved in the planned solutions lied on the other personnel, thus adding to their existing workloads. In order to make the additional tasks and duties of the involved practitioners as minimal as possible, the decision was made to introduce a diverse set of measures so that they could be accomplished during different times by the staff members who were able to apply them without it producing a significant negative effect on their daily schedules and responsibilities.
As the problems of nursing skills shortage and understaffing are very common in many healthcare systems all around the world, there have been developed several different approaches to and solutions for this issue (Henriksen, et al., 2015; Moates, 2014). Palmetto hospital has an active staffing and recruitment tactic; however, the strategy that is generally effective turned out to be rather time-consuming. As a result, a decision was made to adjust the recruitment approach in a way to process the same number of applications in a more cost-effective and quick manner enabling a faster hiring procedure. In addition, a system was established focused on the provision of training and adaptation of the new professionals so that the complications typical for the initial stages of employment of the new nurses are minimized. The initiative involved leadership tasks and team-building events helping the staff bond and form effective and operational teams faster.
To sum up, the quality improvement process that is applied to the staffing strategy and related tasks in Palmetto hospital was initiated due to a set of serious problems resulting in the adverse patient outcomes, the increased rate of turnover intention among the employed staff members, the growing prevalence of stress, and a complicated retention process. All in all, the effects produced by the nursing understaffing caused diminished organizational performance and quality of the delivered care. A complex initiative is in place in order to address the emerged challenges that target the present staffing and recruitment strategies of the organization, the elimination of the adverse effects understaffing have produced on the patients; also, it attempts to carry out the desired practices without overworking the involved practitioners and forcing the cycle of failure and effect to continue.
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Henriksen, K., Battles, J. B., & Marks, E. S. (2015). Advances in patient safety: From research to implementation. Rockville, MD: Agency for Healthcare Research and Quality.
Hughes, R. G. (2008). Patient safety and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality.
Moates, C. R. (2014). Association between nurse staffing indicators, patient falls, and hospital acquired pressure ulcers in the acute care setting. Web.
Rapin, J., D’Amour, D., & Dubois, C. (2015). Indicators for evaluating the performance and quality of care of ambulatory care nurses. Nursing Research and Practice, 2015, 1-9.