Summary
People strive to improve, but it usually comes at a price. Organizations have to consider how to boost effectiveness, whether by increasing the amount of equipment and personnel or working in the existing state. There might not be the right answer, as it depends on the financial and human resources factors of a particular organizational body. However, the intensive type of improvement will allow organizations to avoid problems with hiring new staff and buying the same type of equipment in bigger numbers. This essay will discuss a quality improvement opportunity, the circumstances surrounding it, and how the results of the initiative can be evaluated.
Question
My hospital has encountered a problem that would require a quality improvement plan to be considered and implemented. The patients have been sending numerous complaints about the care they receive from the cardiac unit nurses. Also, the relatives of those patients who passed away during their hospitalization, who are, for the most part, infants and older patients, tend to blame the hospital for not taking all necessary measures. They believe that the staff is underqualified and requires additional training, with some patients insisting on seeing a certificate that attests to a nurse’s education level. Although the problem may appear to be common, it is an urgent issue for our organization and the cardiac unit, in particular. However, nurses individually and the hospital at large are not able to afford a big profile retraining initiative at medical universities. The managers consider room for a forced training program, although it is questionable whether it will help achieve the anticipated result. In the worst-case scenario, it might be a waste of money, as the nurses might insist on applying the methods that they already learned and continuously use in their practice.
The quality improvement program would need to address the potential issues and outline the desired result. In this case, the expected outcome would be the decreased mortality rates of infants and older patients. Although the complaints could be the incentive for the program’s implementation, the ultimate goal is to achieve a better quality of care, which is the underlying cause. The suggested quality improvement initiative would be a complex program that involves short-term multimedia-based courses and self-retraining of the managing body. It would allow the hospital to cut costs and make it a self-sustained organization as far as quality improvement is concerned. The managers will study evidence-based practice and apply it first to their administrative work, then the leading nurses will apply it to theirs. The mode of work will gradually achieve the commonplace status within the cardiac unit. During the short-term courses, the details of how the new practice works could be explained to the rest of the nurses. Such training programs will also focus on presenting the latest research data gathered with the help of evidence-based practice. In the end, the quality improvement process will become a usual, subtle, and low-investment occurrence that will lead to the proposed outcome.
Finding and Appraising of the Evidence
Evidence-based medicine practice has spread in recent years, and some results might be instrumental in solving the presented problem. For example, Anderson et al. (2015) studied the effect of the National Pediatric Cardiology Quality Improvement Collaborative which focused on reducing mortality by forming learning community networks, with the care process being considered as an aspect thereof. The initiative was successful, as the mortality decreased, and it served as a valid alternative to a multiple-year retraining program. Barach and Kleimann (2018) suggest a concept of “continuous quality improvement” which is fully based on evidence-based practice and requires no retraining for nurses. However, managers might have to undergo additional training to regulate the process of improvement, such as being responsible for the initial road to evidence-based practice for the nurses and supervising every step in its implementation (Barach & Kleimann, 2018). Although it demonstrated no practical results, it may be useful to apply some of the theory to the suggested initiative.
Some short-term quality improvement projects have managed to provide a considerable result. For example, Rostamnia et al. (2020) examined two methods of enhancing nursing skills: a two-day training program and a multimedia course. The results of the groups that received additional training were superior to those of the control group who received no educational content (Rostamnia et al., 2020). No significant differences between the trained group were established which could mean that a multimedia course, which cost is also low, is an alternative that should be considered while constructing a similar program.
Implementation
To implement the initiative successfully, several essential steps should be followed. First of all, the complaints should be analyzed to identify the particular grounds for dissatisfaction. The patient records might have to be reexamined to understand what led to a specific outcome. Then the managers will get acquainted with the basics of evidence-based practice and discover which elements are of special interest to the cardiac unit. It might require a collaboration with the leading nurses of the staff’s inclinations and drawbacks. After engaging in the collaborative efforts, the initiative team will form a small group of nurses, including those who were involved in the cases highlighted in the complaints. Although the group could involve all the nurses with complaints, it is important to note if quality improvement can positively impact average-performing and well-performing nurses. It might be beneficial to convince the nurses of the necessity of the course beforehand. The managers should discuss the compensation for the training days and consider the measures that will not considerably increase the rest of the nursing staff’s workload. These steps coincide with the planning stage of the PSDA cycle.
Once a group is formed, it will take a short-term multimedia course made by the administrative staff in collaboration with the leading nurses. The course will address the potential causes of the received complaints and how such issues are resolved according to the recent developments in general medical and cardiac research. Before the training, the nurses’ performance will be evaluated to ensure that the group is varied, and they will be reevaluated a month after the end of the course. The described steps belong to the doing state of the PSDA cycle, and the analysis of the reevaluation is the study stage. If the final results are better than there were initially, then the practice of such courses can be made common which is the active stage of the cycle. If the results are somehow worse or remain the same, a further investigation into the course details will be necessary. Perhaps, in that case, the focus will be shifted from the complaints to an individual nurse’s needs. Overall, the underlines steps should guarantee the successful implementation of the quality improvement proposal.
Evaluation
The initiative’s success will be measured using three main factors. They include the mortality rates of the infants and the older patients, which will require two separate scales for accuracy, and the patients’ satisfaction rate, which will reflect whether the complaints are addressed properly. These are the three variables that will have to be measured during the beginning of the planning stage before the managers begin their self-training. The hypothesis is that there will be a positive effect of implementing the quality improvement initiative on the mortality rates of the groups in question and the patients’ satisfaction rate. The statistical test used to confirm the hypothesis will be a paired t-test, which will compare the three variables before the initiative to their post-initiative values. Thus, if the values of the mortality rates decrease and the value for the patients’ satisfactory rate increases, the hypothesis will be proven correct.
Conclusion
To summarize everything, this paper suggests a quality improvement proposal for a cardiac nurse unit that receives complaints about the provided care. The initiative focuses on improving its quality, which may, in turn, impact the mortality rates of the affected patient groups, infants, and older patients. The previous research of similar attempts is analyzed, and the essential steps that should be followed to ensure the desired outcome of the initiative are described. In the end, the explanation of how the success of the quality improvement initiative can be evaluated is given.
References
Anderson, J. B., Beekman, R. H., Kugler, J. D., Rosenthal, G. L., Jenkins, K. J., Klitzner, T. S., Martin, G. R., Neish, S. R., Brown, D. W., Mangeot, C., King, E., Peterson, L. E., Provost, L., & Lannon, C. (2015). Improvement in Interstage Survival in a National Pediatric Cardiology Learning Network. Circulation: Cardiovascular Quality and Outcomes, 8(4), 428–436. Web.
Barach, P., & Kleinman, L. C. (2018). Measuring and improving comprehensive pediatric cardiac care: Learning from continuous quality improvement methods and tools. Progress in Pediatric Cardiology, 48, 82–92. Web.
Rostamnia, L., Ghanbari, V., Shabani, F., Farahani, A., & Dehghan-Nayeri, N. (2020). Evidence-based practice for cardiac intensive care unit nurses: An educational intervention study. The Journal of Continuing Education in Nursing, 51(4), 167-173. Web.