NURS 4220 WK 3 DISCUSSION: APPLYING PERFORMANCE IMPROVEMENT TOOLS

Quality Improvement and Scenario Overview

Data collection and evaluation are essential in determining deficiencies and creating effective solutions that result in continuous improvement (Spath et al., 2018, p. 120). The nursing unit in this scenario has the lowest HCAPHS scores in the facility. The unit implemented strategies and interventions from January 14, 2014, until March 1, 2016, when the nursing reached patient satisfaction goals. The unit working with the QI team has created and applied various interventions, including training, lectures, committee meetings, data sharing, and unit reviews, to help improve quality care. The data obtained from the patient surveys over this period has been compiled into a run sheet for evaluation.

Evaluation of Interventions

The nursing unit failed to determine a goal for improvement. For the nursing unit and QI team to judge their interventions, they must define a desired result (Spath et al., 2018, p. 80). The National benchmark standard for patient satisfaction in similar medical-surgical units is 85%, and the nursing unit typically has a satisfaction rate of around 70%. The nursing unit also has the lowest patient satisfaction rating for the facility. These two factors indicate the need for change, but no specific goal for achievement was identified to compare their results. One can only assume that the benchmark of 85% is a desirable outcome.

Interventions for improvement were logged with the date they were performed but lacked information about staff attendance and incentive for attendance in initial log notes. Improvement was made in later intervention logs noting faculty attendance to trainings and incentives to boost attendance. The log also includes dates of relevant meetings held by the QI team and the objective of the meetings.

The nursing unit specifically addressed pain management to improve patient satisfaction. While pain management is essential to patient satisfaction, it is not a specific component of HCAPH scoring (CMS, 2021). HCAPH scores evaluate the patient’s experience with doctors, the responsiveness of staff members, the environment of the facility related to cleanliness and quietness, communication regarding medications and discharge, and transition of care and scoring of the facility as a whole (CMS, 2021). Limiting interventions to address pain management can limit the unit’s overall improvement.

Validity of the Run Sheet and Results

A line graph or run chart was used to record patient satisfaction each month from January 1, 2014, until May 1, 2016 (Spath, 2018, p. 94). The line graph is appropriate for this study as the unit explicitly tracks only patient satisfaction in this scenario and effectively shows change over time (Spath, 2018, p. 94). The run report needs an expectation line as there is no clear expectation. Utilizing an expectation line is helpful in quickly visualizing performance VS expectations (Spath, 2018, p.99).

The run sheet shows a positive trend in patient satisfaction rates over the period it has been applied. It is difficult to determine an exact performance percentage based on the run sheet due to a 20-point gap between the percentage of very satisfied patients and the lack of expectation line. The QI team and the nursing unit should work to determine an expected goal and insert an expectation line into the run sheet. In order to clarify the values on the run sheet, the data points should be marked with exact percentages at that time (Spath, 2018, pp. 95-96). Including a benchmark line for comparison will help show if the unit is meeting the benchmark quickly and clearly.

The nursing unit can celebrate continuous improvement but should wait to celebrate victory until a clear expectation goal is determined and met. While it is plausible that nursing management and administration can expect the unit to exceed patient satisfaction benchmarks this quarter, the exact satisfaction percentage needs to be clarified due to the lack of data points marked with numbers and a lack of a benchmark line for comparison.

References:

Hospital CAHPS (HCAHPS). CMS. (2021, December 1). Retrieved January 23, 2023, from https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/HCAHPS1

Spath, P. (2018). Introduction to healthcare quality management (3rd ed.). Health Administration Press

        Nurses put a lot of effort into giving patients the best possible treatment and increasing their level of satisfaction. The usage of benchmarks, which are utilized in many hospital settings to evaluate the hospital’s achieved performance statistics to other hospital data, is a critical factor in determining the quality of the care provided (Spath, 2018). Most of the data gathered by the hospital can be compared and examined as benchmark data. The scenario for this week contrasts the pain management satisfaction scores in a geriatric medical-surgical unit and its plans to raise the scores, which, despite numerous interventions and training, are still below the country’s average of 85%.

            Hospitalized patients frequently experience pain, especially older people who already experience chronic pain. Li et al. (2020) describe how dynamic pain management is essential for managing pain in the elderly and how chronic pain is a severe issue for older persons and their caregivers. In addition to ensuring that all patients are comfortable and heal effectively, managing pain is essential for the Hospital Consumer Assessment of Healthcare Providers and Systems Survey’s overall satisfaction rankings. Preliminary data suggest that some healthcare professionals are under pressure to prescribe opioids to ensure patients are satisfied with their pain management; this evidence is mainly based on qualitative investigations (Scher, 2018). However, there is growing evidence that existing efforts to encourage pain evaluation across therapeutic contexts have fallen short of their goals and may even be partially responsible for the present opioid crisis (Scher, 2018).

            Hospitals are changing how they assess and manage their healthcare organizations due to the growing significance of patient satisfaction and the Hospital Consumer Assessment of Healthcare Providers and Systems ratings mandated by the Centers for Medicare and Medicaid Services (Burgener, 2020). An inter-professional team approach and multi-dimensional pain assessment tools are required to assess pain more accurately. As new technology such as tablets, smartphones, and mobile apps make it easier to collect patient-level data, nurses can also take the initiative in this area (Scher, 2018). Patients can complete the questionnaires before being discharged with the help of nurses. Having patients complete a satisfaction survey before discharge often results in higher scores.

References

Burgener, Audrey M. BS, MBA. Enhancing Communication to Improve Patient Safety and to

         Increase Patient Satisfaction. The Health Care Manager 39(3):p 128-132, 7/9 2020. | DOI: 10.1097/HCM.0000000000000298

Li, Y., Liu, M., Sun, X. et al. Independent and synergistic effects of pain, insomnia, and

       depression on falls among older adults: a longitudinal study. BMC Geriatr 20, 491 (2020). https://doi.org/10.1186/s12877-020-01887-zLinks to an external site.

Scher, C., Meador, L., Van Cleave, J. H., & Reid, M. C. (2018). Moving Beyond Pain as the

Fifth Vital Sign and Patient Satisfaction Scores to Improve Pain Care in the 21st Century. Pain Management Nursing, 19(2), 125-129.                                        https://doi.org/10.1016/j.pmn.2017.10.010Links to an external site.

Spath, P. (2018). Introduction to Healthcare Quality Management, Third Edition (Gateway

      to  Healthcare Management) (Third). Health Administration Press (pp. 119-142)

Hi Heather. Your discussion post was very informative regarding pain management in the elderly. The scenario information provided much education without sustainable increased performance measures. It wasn’t until visual aids and tested quality measures were implemented that a sustainable increase in satisfaction was noted.

I agree that asking the patient to provide feedback before discharge may result in a higher return of survey information. In this case, the more information received, the less detrimental 1-2 bad surveys will be. Since only 25% of surveys were being returned, one would hope that implementing this method may provide a better outcome. However, I do not believe this method alone would provide the sustainability the CNO is looking for.

When the QI team met with staff to strategize and implement the rapid cycle improvement model (RCI) with plan-do-study-act (PDSA), numbers began to climb and, according to the provided run chart, were sustained. RCI with PDSA incorporates several small process changes and measurements to achieve an improvement goal. Each process is put through the PDSA model until the goal is achieved (Spath, 2018). One of the measurements possibly put into effect was the handoff report. In the scenario, only the day shift is mentioned. The entire unit must be on board to affect change. The Joint Commission supports using standardized bedside reports to positively impact nursing workflow and patient satisfaction (Gates et al., 2021).

Once RCI with PDSA was implemented, positive, sustainable satisfaction was achieved according to the run chart. Run charts allow us to understand how the changes we make to a process over time lead to improvements. This method is of greater value and easier to understand than most statistical models. Due to the run charts’ simplicity, it has wide potential application in healthcare for practitioners and decision-makers (Perla et al., 2010).

References

Gates, C., Goff, L., & Thomas, L. (2021). Reinventing the handoff process: Bringing standardized bedside report to perioperative services. Journal of PeriAnesthesia Nursing, 36(4), e1–e19. https://doi.org/10.1016/j.jopan/2021.06.041Links to an external site.

Perla, R. J., Provost, L. P., & Murray, S. K. (2010). The run chart: a simple analytical tool for learning from variation in healthcare processes. BMJ Quality and Safety, 20(1), 46–51. https://doi.org/10.1136/bmjqs.2009.037895Links to an external site.

Spath, P. (2018). Introduction to healthcare quality management (3rd ed.). Health Administration Press.

Hi Heather. Your discussion post was very informative regarding pain management in the elderly. The scenario information provided much education without sustainable increased performance measures. It wasn’t until visual aids and tested quality measures were implemented that a sustainable increase in satisfaction was noted.

I agree that asking the patient to provide feedback before discharge may result in a higher return of survey information. In this case, the more information received, the less detrimental 1-2 bad surveys will be. Since only 25% of surveys were being returned, one would hope that implementing this method may provide a better outcome. However, I do not believe this method alone would provide the sustainability the CNO is looking for.

When the QI team met with staff to strategize and implement the rapid cycle improvement model (RCI) with plan-do-study-act (PDSA), numbers began to climb and, according to the provided run chart, were sustained. RCI with PDSA incorporates several small process changes and measurements to achieve an improvement goal. Each process is put through the PDSA model until the goal is achieved (Spath, 2018). One of the measurements possibly put into effect was the handoff report. In the scenario, only the day shift is mentioned. The entire unit must be on board to affect change. The Joint Commission supports using standardized bedside reports to positively impact nursing workflow and patient satisfaction (Gates et al., 2021).

Once RCI with PDSA was implemented, positive, sustainable satisfaction was achieved according to the run chart. Run charts allow us to understand how the changes we make to a process over time lead to improvements. This method is of greater value and easier to understand than most statistical models. Due to the run charts’ simplicity, it has wide potential application in healthcare for practitioners and decision-makers (Perla et al., 2010).

References

Gates, C., Goff, L., & Thomas, L. (2021). Reinventing the handoff process: Bringing standardized bedside report to perioperative services. Journal of PeriAnesthesia Nursing, 36(4), e1–e19. https://doi.org/10.1016/j.jopan/2021.06.041Links to an external site.

Perla, R. J., Provost, L. P., & Murray, S. K. (2010). The run chart: a simple analytical tool for learning from variation in healthcare processes. BMJ Quality and Safety, 20(1), 46–51. https://doi.org/10.1136/bmjqs.2009.037895Links to an external site.

Spath, P. (2018). Introduction to healthcare quality management (3rd ed.). Health Administration Press.