Describe a quality improvement initiative in your current or recent practice setting. What was the nurses role in the project? What was the outcome of the project? Has the improvement been sustained? Why or why not?
Submission Instructions:
Your initial post should be at least 500 words,formatted and cited in current APA style with support from at least 2 academic sources.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts.All replies must be constructive and use literature where possible.
#1
Milaine Garcia
St. Thomas University
NUR 416 AP 2
Instructor Lisbet Henriquez
October 6, 2022
Quality Improvement Initiative
As a health insurance company, my organization faces numerous challenges that may jeopardize the quality and safety of patient care, requiring the development of Quality Improvement programs. Quality Improvement is the methodical use of data to assess the results of care processes, along with the use of improvement techniques to plan and test practice modifications with the goal of continuously enhancing the quality and safety of healthcare systems (LoBiondo-Wood & Haber, 2018). Quality Improvement is essential for patient care. As health organizations work to increase efficiency, lower healthcare costs, and guarantee high-quality patient outcomes, the nursing profession and healthcare systems as a whole, are placing an increasing emphasis on improving healthcare quality and safety (Adolfo et al., 2021).
In my organization, there have been many changes throughout the years. The latest Quality Improvement Initiative implemented was to select a new electronic documentation system provider. This was done after analyzing various difficulties and disadvantages that were in place with the previous charting system. After careful consideration, the decision was made to implement a new system. The objective was to select a system that allowed for the better and safest way to document, and store protected health information for the patients. This project included many individuals from various areas of the company. There is a team in my facility that is entirely responsible for quality improvement, and it comprises nurses. However, whenever a new initiative is planned, it is shared with other departments to get their input.
The majority of healthcare is provided by nurses, who thus have a significant impact on the industry’s overall standard of care (Adolfo et al., 2021). However, members of the lead team for quality improvement should represent a variety of healthcare-related professions, and from support personnel, patients, and families (LoBiondo-Wood & Haber, 2018). Nonetheless, the lead team members are responsible for organizing, coordinating, carrying out, and reviewing improvement initiatives.
In my organization, these principles are carried out. Nurses played a significant role in this quality improvement initiative. They helped in designing the project since they know what the system would require in order to better assist the patients. Nurses also helped in the implementation of the new charting system. They used it to document interactions with patients, and providers, and to store all data involved in each patients care. Additionally, they were tasked with the evaluation of the effectiveness of the initiative. Overall, nurses had a significant impact on this initiative.
The outcome of the project was positive. It improved both the coordination of patients’ needs and the provision of care. The new system allowed for the time spent in each case to be reduced, therefore, optimizing patient care. The patient health information was now safely stored and easily accessible to authorized personnel. The improvement has been sustained for over a year now due to the positive outcomes. After the results were evaluated by the Quality Improvement team and the nurse’s feedback, positive outcomes were demonstrated by the data presented. Hence, the initiative demonstrated to have been successful.
References
Adolfo, C., Albougami, A., Roque, M., & Almazan, J. (2021, April 11). Nurses attitudes toward quality improvement in hospitals: Implications for nursing management systems.
Nursing Practice Today. https://doi.org/10.18502/npt.v8i3.5935
LoBiondo-Wood, G., & Haber, J. (2018).
Nursing research: Methods and critical appraisal for evidence-based practice(9th ed.). Elsevier.
#2
Lisa Wright
St. Thomas University
NUR 416: Nursing Research & Evidence-Based Practice
Lisbet Henriquez
October 06, 2022
Quality Improvement Initiative
Quality improvement (QI) initiatives are programs undertaken in healthcare to address the shortcomings that a facility may be facing in certain areas. They seek to investigate these areas and design remedies in the form of interventions seeking recourse for healthcare benefits. QI initiatives are highly effective and paramount in improving patient outcomes and making the healthcare environment more productive and safer for patients and professionals (Backhouse & Ogunlayi, 2020). This assignment module examines a QI initiative in my practice, nurses role in the project, the outcomes of the project, and its sustainability.
Quality Improvement Initiative
A QI initiative I have been a part of is a program that seeks to address interdepartmental coordination to enhance patient care and improve patient outcomes. Effective and efficient harmony between departments of healthcare is paramount. It must be prioritized to ensure that every professionals contribution to care is equally valuable and contributes to the patients recovery (Persson et al., 2022). Every professional, from the nursing to technicians, to surgeons, to the pharmacy, has a critical role in care delivery. As a nurse, for instance, my level of patient contact differs from a physicians, making my perception of the patient different from theirs. A technicians view is also primarily different because they work behind the scenes. When all parties work cohesively as a unit, every aspect of care is enhanced, and care delivery is optimized.
Nurses Role
The nurses role in this initiative was to uphold and enhance communication. This aspect of interdepartmental collaboration is critical for the initiatives success in upholding care delivery at large. As a MedSurg nurse, I have to ensure that my records on the patient are taken keenly and communicated accordingly with other departments and professionals to ensure that the patients care is as efficient as possible. The nurse also must ensure transparency by relating and learning from other team members and stakeholders (Brown et al., 2018). Divisions that separate the departments are eliminated by working as a unit where the weaknesses and strengths are learned and addressed accordingly. As nurses, we must be open-minded about ways to better integrate with other departments through learning and close collaboration.
Projects Outcome
Among the outcomes of the initiative included a feeling of empowerment by working collaboratively where no department is seen as more important than the other. Every team member can make recommendations about the care that has an equal chance of being executed. It also enabled comprehensive care delivery where a collective effort from different departments to patient care gives it a comprehensive view that ensures the most insightful view of care. This translated and still translates to optimized health outcomes. The third outcome was a collaborative team mentality where the team working across departments ensured support and deconstruction of previous divides. It also led to personalized patient care where a patients needs were examined through a lens from different angles giving the patients intervention a unique angle.
Initiatives Sustainability
The initiative was sustained, and one of the ways this was realized was by enshrining it into the facilitys culture. The workforce was engaged before and after the initiatives implementation and encouraged to keep the practice going. The facilitys processes were also geared to cross-departmental bounds to encourage the elimination of the departmental divides that existed prior. The initiative was sustained to ensure improved care efficiency and patient outcomes were maintained, and making change the norm was the best way to ensure this outcome.
Conclusion
QI is inevitable primarily because healthcare is dynamic. We need to keep looking for ways to improve care and improve patients experiences and outcomes as they can. The healthcare facility also needs to be optimized to benefit healthcare professionals as their positive experience translates to improved patient outcomes. We are grappling with multiple healthcare issues like staffing and shifting the healthcare landscape through health conditions. We must adjust accordingly to ensure the healthcare systems stability remains intact. This assignment module examined a QI initiative in my practice, nurses role in the project, the outcomes of the project, and its sustainability.
References
Backhouse, A., & Ogunlayi, F. (2020). Clinical updates: Quality improvement into practice.
The BMJ,
368. https://doi.org/10.1136/BMJ.M865
Brown, L. J. E., Dickinson, T., Smith, S., Brown Wilson, C., Horne, M., Torkington, K., & Simpson, P. (2018). Openness, inclusion, and transparency in the practice of public involvement in research: A reflective exercise to develop best practice recommendations.
Health Expectations: An International Journal of Public Participation in Health Care and Health Policy,
21(2), 441. https://doi.org/10.1111/HEX.12609
Persson, M. H., Sndergaard, J., Mogensen, C. B., Skjt-Arkil, H., & Andersen, P. T. (2022). Healthcare professionals experiences and attitudes to care coordination across health sectors: An interview study.
BMC Geriatrics,
22(1). https://doi.org/10.1186/S12877-022-03200-6
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Wk 6, HCS 577: Health Care Business Analysis
***** See Wk 6 – Assignment Content *****
Health Care Business Analysis
Assignment Content
Top of Form
Resources:Budgets under Chief Financial Officer in the Patton-Fuller Community Hospital Virtual Organization and the Health Care Budget assignment from Week Five.
Part 1: 2010 Operating Budget
Reviewthe 2009 Budget Issues – Nurses file in the
Patton-Fuller Community Hospital Virtual Organization
.This document can be found on the Chief Financial Officer’s web page under Special Projects.
Decidewhich of the two highlighted options you will implement from the Nursing Statistics memo of the 2009 Budget Issues – Nurses document.
Discuss decision-making processes in creating a budget.
Createa new 2010 Operating Budget based on the labor decision you select from the Nursing Statistics memo.
Useyour Week 5 Health Care Budget, see attachment, assignment as the foundation to develop your new projected budget.
Part 2: Analysis Paper
Writea 1,050- to 1,400-word paper. Your paper should:
Discuss decision-making processes in creating a budget.
Explain the role of variance analysis in maintaining an operating budget.
Differentiate between managerial accounting and financial management.
Explain generally accepted accounting principles applied to the health care industry and how they are applied to your Operating Budget Projection.
Discuss the decision between the two labor alternatives facing the management of PFCH and the annual cost increase of each.
Make a recommendation about which labor alternative should be chosen.
Justify and analyze the labor decision that you recommend. Your justification should present numbers related to fiscal management including how each decision affects the 2010 Budget Projection.
Analyze the effect of your decision on the operating budget, including:
The opportunity cost of your recommendation
How your recommendation affects employee satisfaction
How your recommendation affects patient care and patient satisfaction
Cite a minimum of 5 sources.
Format your sources according to APA guidelines.
Bottom of Form PFCH Email Record
From: Davis Geach <[emailprotected]>
To: Zachary Hardie
Subject: Increase in nursing staff
Zach:
Caterina has been insisting for some time that we need to hire more
nurses. Ive arranged for her to give a presentation to the Board next
month to plead her case. I know that following her presentation, they
will want me to advise them of any alternatives.
Caterinas argument is that the nurses are over-worked and that has a
negative effect on patient care and also leads to the nurses leaving
PFCH for other hospitals. Im wondering whether giving the nurses a
raise might solve the problems.
Please put together some numbers to compare hiring more nurses versus
giving the nurses a raise.
Davis Geach, President/CEO
Please consider the environment before printing this email.
This message is private and confidential. If you have received
it in error, please contact the sender immediately and delete it
from your system.
PFCH Email Record
From: Zachary Hardie <[emailprotected]>
To: Caterina Hossack
Subject: Re: Increase in nursing staff
Hi Caterina.
Mr. Geach asked me to prepare some information for the Board of
Directors relating to your proposal to add more nurses to the hospital
staff. In order to do this, I need to know the current nursing ratio
and what nursing ratio you are proposing.
Thanks for your help.
Zachary Hardie, Chief Financial Officer
Please consider the environment before printing this email.
This message is private and confidential. If you have received
it in error, please contact the sender immediately and delete it
from your system.
PFCH Email Record
From: Caterina Hossack <[emailprotected]>
To: Zachary Hardie
Subject: Re: Increase in nursing staff
The hospital currently maintains a 5 to 1 nursing ratio (5 patients for
every nurse). I will suggest to the Board of Directors that we move to
a 4 to 1 nursing ratio (4 patients per nurse).
Will the information that you are preparing address patient care,
worker satisfaction and nursing turnover?
Caterina Hossack, Chief Nursing Officer
Please consider the environment before printing this email.
This message is private and confidential. If you have received
it in error, please contact the sender immediately and delete it
from your system.
PATTON FULLER COMMUNITY HOSPITAL
From: Zachary Hardie, CFO
To: Davis Geach, President/CEO
Re: Increase in nursing staff
Per your request, I have prepared a financial analysis comparing the increasing of the
nursing staff to the granting of an across the board raise to the existing nursing staff.
In order to have a common basis for the comparison, it was necessary to take our existing
salary and benefit costs for the nursing staff and show how they related to the existing
patient/nurse ratio. I have attached as an exhibit a table that presents our current patient
statistics. While the hospital has a capacity of 600 beds, we generally have only 60% of
the beds occupied. The occupancy of the hospital is also affected by well-established
seasonal fluctuations. Using the average occupancy and the expected seasonal
fluctuations, we try to anticipate our daily and monthly patient loads and match our
staffing needs accordingly. The attached table sets forth that modeling and shows how
changes in the daily and monthly patient census affect our patient revenues.
Also attached is a second table that deals with our nursing statistics. Using the expected
number of patients per day from the first table, it sets out how many nurses would be
required to serve the patients ,based on our existing 5 to 1 nursing ratio, and then what
the cost of those nurses is based on the existing average salary and benefits of the nurses,
expressed as an hourly wage of $30 per hour. The table then sets forth how the nursing
costs would be changed by either giving the nurses a $1 per hour raise or by changing the
hospitals nursing ration to 4 to 1 (4 patients for every nurse).
If you need any additonal information, please let me know.
Jan Feb Mar Apr May Jun
Days in the month 31 28 31 30 31 30
Patient Days (60% occ x seasonal x days in month) 13,271 11,983 12,286 10,171 9,092 7,258
Average Census:
Patton Fuller # of beds= 600
Patton Fuller avg occupancy (HFMA) 60%
Patton Fuller Avg Daily Census (ADC) 360
Month as % of Average “Seasonal Adjustment” 119% 119% 110% 94% 81% 67%
Patton Fuller Avg Daily Census w/seasonal adj. 428 428 396 339 293 242
Patton Fuller Avg Net Rev/pt day $ 3,500
Average Daily Revenue 1,498,381 1,497,857 1,387,134 1,186,616 1,026,495 846,801
Patton Fuller Avg Net Rev/month (1000’s) $ 46,450 $ 41,940 $ 43,001 $ 35,598 $ 31,821 $ 25,404
Patton – Fuller Community Hospital
Patient Statistics
C:\Documents and Settings\mkriorda\My Documents\Web Development\CIST Server\CIST\VOP Development\Healthcare\PFCH\HosDepts\CFO\2009
Financial Statements\2009PatientStatsPDF.xls
Jul Aug Sep Oct Nov Dec Total
Days in the month 31 31 30 31 30 31 365
Patient Days (60% occ x seasonal x days in month) 7,294 10,723 11,182 11,607 13,419 13,113 131,400
Average Census:
Patton Fuller # of beds= 600
Patton Fuller avg occupancy (HFMA) 60%
Patton Fuller Avg Daily Census (ADC) 360
Month as % of Average “Seasonal Adjustment” 65% 96% 104% 104% 124% 117% 100%
Patton Fuller Avg Daily Census w/seasonal adj. 235 346 373 374 447 423
Patton Fuller Avg Net Rev/pt day $ 3,500
Average Daily Revenue 823,560 1,210,686 1,304,520 1,310,523 1,565,592 1,480,451
Patton Fuller Avg Net Rev/month (1000’s) $ 25,530 $ 37,531 $ 39,136 $ 40,626 $ 46,968 $ 45,894 $ 459,900
Patton – Fuller Community Hospital
Patient Statistics
C:\Documents and Settings\mkriorda\My Documents\Web Development\CIST Server\CIST\VOP Development\Healthcare\PFCH\HosDepts\CFO\2009
Financial Statements\2009PatientStatsPDF.xls
Jan Feb Mar Apr May Jun
Number of Patients per day 428 428 396 339 293 242
Cost of nurse per hour w/benefits 30.00$ 30.00$ 30.00$ 30.00$ 30.00$ 30.00$
Cost of nurse per 24hour day 720.00$ 720.00$ 720.00$ 720.00$ 720.00$ 720.00$
Number of nurses per patient based on 5 patients per nurse or a “5
to 1” nursing ratio 0.2
Number of nurses per day 85.6 85.6 79.3 67.8 58.7 48.4
Nursing cost per day 61,648$ 61,626$ 57,071$ 48,821$ 42,233$ 34,840$
Nursing cost per month 1,911,078$ 1,725,532$ 1,769,190$ 1,464,623$ 1,309,221$ 1,045,194$
Simulation: Effect of a $1 per hour raise for all nurses
Cost of nurse per hour w/benefits 31.00$ 31.00$ 31.00$ 31.00$ 31.00$ 31.00$
744.00$ 744.00$ 744.00$ 744.00$ 744.00$ 744.00$
Number of nurses per patient based on a ratio of 5 patients per nurse
or a “5 to 1” nursing ratio 0.2
Number of nurses per day 85.6 85.6 79.3 67.8 58.7 48.4
Nursing cost per day 63,703$ 63,680$ 58,973$ 50,448$ 43,641$ 36,001$
Nursing cost per month 1,974,781$ 1,783,050$ 1,828,163$ 1,513,444$ 1,352,862$ 1,080,034$
Increase in cost per month due to a $1 raise per nursing hour 63,702.62$ 57,517.73$ 58,973.00$ 48,820.77$ 43,640.71$ 34,839.80$
Simulation: Effect of changing to a “4 to 1” nursing ratio
Number of nurses per day 0.25 107.0 107.0 99.1 84.8 73.3 60.5
Nursing cost per day (Nursing ratio of “4 to 1” and an hourly rate of
$30 ) 77,060$ 77,033$ 71,338$ 61,026$ 52,791$ 43,550$
Nursing cost per month 2,388,848$ 2,156,915$ 2,211,487$ 1,830,779$ 1,636,527$ 1,306,493$
Increase in cost per month due to a change in nursing ratio
from 5 to 1 down to 4 to 1 477,770$ 431,383$ 442,297$ 366,156$ 327,305$ 261,299$
Nursing Statistics
Patton – Fuller Community Hospital
C:\Documents and Settings\mkriorda\My Documents\Web Development\CIST Server\CIST\VOP Development\Healthcare\PFCH\HosDepts\CFO\2009
Financial Statements\2009NursingStatsPDF.xls
Jul Aug Sep Oct Nov Dec Total
Number of Patients per day 235 346 373 374 447 423
Cost of nurse per hour w/benefits 30.00$ 30.00$ 30.00$ 30.00$ 30.00$ 30.00$
Cost of nurse per 24hour day 720.00$ 720.00$ 720.00$ 720.00$ 720.00$ 720.00$
Number of nurses per patient based on 5 patients per nurse or a “5
to 1” nursing ratio 0.2
Number of nurses per day 47.1 69.2 74.5 74.9 89.5 84.6
Nursing cost per day 33,884 49,811 53,672 53,919 64,413 60,910
Nursing cost per month 1,050,392 1,544,143 1,610,150 1,671,479 1,932,388 1,888,210
Simulation: Effect of a $1 per hour raise for all nurses
Cost of nurse per hour w/benefits 31.00$ 31.00$ 31.00$ 31.00$ 31.00$ 31.00$
744.00$ 744.00$ 744.00$ 744.00$ 744.00$ 744.00$
Number of nurses per patient based on a ratio of 5 patients per nurse
or a “5 to 1” nursing ratio 0.2
Number of nurses per day 47.1 69.2 74.5 74.9 89.5 84.6
Nursing cost per day 35,013$ 51,471$ 55,461$ 55,716$ 66,560$ 62,940$
Nursing cost per month 1,085,405$ 1,595,615$ 1,663,822$ 1,727,195$ 1,996,801$ 1,951,150$
Increase in cost per month due to a $1 raise per nursing hour 35,013.05$ 51,471.44$ 53,671.66$ 55,715.97$ 64,412.93$ 62,940.33$ $ 630,720.01
Simulation: Effect of changing to a “4 to 1” nursing ratio
Number of nurses per day 0.25 58.8 86.5 93.2 93.6 111.8 105.7
Nursing cost per day (Nursing ratio of “4 to 1” and an hourly rate of
$30 ) 42,354$ 62,264$ 67,090$ 67,398$ 80,516$ 76,137$
Nursing cost per month 1,312,989$ 1,930,179$ 2,012,687$ 2,089,349$ 2,415,485$ 2,360,262$
Increase in cost per month due to a change in nursing ratio
from 5 to 1 down to 4 to 1 262,598$ 386,036$ 402,537$ 417,870$ 483,097$ 472,052$ 4,730,400$
Patton – Fuller Community Hospital
Nursing Statistics
C:\Documents and Settings\mkriorda\My Documents\Web Development\CIST Server\CIST\VOP Development\Healthcare\PFCH\HosDepts\CFO\2009
Financial Statements\2009NursingStatsPDF.xls
NursingOptFolder
NursingMemo1
NursingMemo2
NursingMemo3
NursingMemo4docx
2009PatientStatsPDF
2009NursingStatsPDF