Quality Improvement or Patient Safetychange Initiative in your Department

Patient safety refers to how health care institutions and hospitals protect patients from possible injuries, medical errors, infections and accidents (Aiken et al, 2012). It is the responsibility of hospitals and health care facilities to ensure that their patients are protected and safe while they are being attended to.  The patient safety greatly impacts the recovery process. If a patient suffers recovery will take longer, sometimes even life can be lost. For example, if medical error results to air embolism (air bubble in the blood), the patient is likely to have a stroke or even lose his or her life. The air bubbles interfere with the blood flow through the body hence the stroke (Murray et al., 2013). In the United States, it is approximated that 440,000 people lose their lives due to medical errors, 1 out of 25 patients gets an infection, 1 out 4 Medicare suffers injuries or harm when gets admitted and over 1000 patients are likely to die due to preventable medical errors(Makary $ Daniel, 2016).  This figure is very high and should worry the stakeholders in the health care provision. Whereas there no hospital or health facility that is totally immune from potential dangers, safety measures can be put in place to protect the patients. For instance, having a strong team of health care providers can minimize the rate of infections. In addition, the strong team can come up with measures to prevent possible mistakes and medical errors that might occur in the process.  This can be done by having an efficient and clear means of communication among the staff, patient and the patients’ family. An inefficient team in the hospital is an open risk to patients. These disturbing figures form the basis of this project which aims at creating a safer environment both the medical staff and the patients. According to the study by Coetze et al (2013) the patients’ safety is closely tied to the medical staffs’ welfare.  Studies have shown that fatigue in nurses have a negative impact on the safety of the patients. Yoder (2014) found out that fatigue increases chances of having medical errors such wrong diagnosis

Aims

These are what should be accomplished at the end of the project.

1. Patients record zero harm while receiving care
2. There is improved an improvement in access to health care services.
3. Improved patient experience with the care givers.
4. Minimize hospital readmissions

The above aims will be achieved by using the road maps below. Aim 1: Patients record zero harm while receiving care

1. a) Minimizing negative effects

The health care givers must ensure there is compliance with the Reduction of Adverse Drug Events or Medical Reconciliation i.e. the medication administered to the patient should be the same as those prescribed by the care giver.

1. b) Minimizing harm via reducing prevalence and cases of Healthcare Acquired Infections

This will be done by ensuring there is compliance Informed care bundles and strategies in the management of MRSA, VRE, C-Diff, surgical site prevention of infections, and hand hygiene. To determine whether there has been an improvement, Hospital Standard Mortality Ration (HSMR) should be below 100 by the end of the next financial year (2018/19) at the strategic level. At both, the unit and program level, Medical Reconciliation, VTE, VRE, Infection on the surgical area are among the factors that will be considered. Aim 2: There is improved an improvement in access to health care services

1. a) Improvement in the flow of patient from admission to discharge.

This will be done by adopting a spread solution that will be piloted with the Emergency Department,

1. b) Minimize the waiting time for planned surgical process

Process related to waiting strategies like the hip and Knees are enhanced

1. c) Improving the care given to the chronic patients i.e. those with Diabetes and Congestive Heart Failure (CHF).

This will be done by the implementation of evidence based population care models. To establish where there has been improvement, at the strategic level the average time taken in ER is expected to reduce by at least 10% at the end of the financial year 2018/19. At program and Unit level, process indicators will be used in monitoring the flow of patients. In addition, the time it takes to replace knee and hip will also be considered. Aim 3: Improved patient experience with the care givers.

1. a) Design a care and service system that gives more room for the patients and their families to voice their concerns. This will be done by creating an advisory to the manager together with the network programs for specific departments with the hospital.
2. b) Enhancing how the hospital collects and analyze the patients’ feedback. This will be done through an improved rigorous process of information collection of feedback from the patients. The information will then be shared among the staff and the physicians. Secondly, the hospital will have to fully fledged and efficient customer service department with qualified personnel.
3. c) Providing patients with information they require in a simple and understandable form.

The improvement will be examined by evaluating if there is an increase in the result of the picker questions. The question asks the patients and their families to give an overall rating of the quality of the service they received from the hospital. An improvement of at least 10% is expected at the end of the financial year 2018/19. At the program and unit level, surveys that focus on the score of Emergency Department will be conducted.  The surveys will seek to establish the general satisfaction with the care provided by the department including pain management. Aim 4: Minimize hospital readmissions

1. a) Improved transition in the line of continuum care. This will be achieved by enhancing admission needs after hospital with focus on friendly referral hospitals, patient and family communication, fool up after discharge from the hospital, coordination with community health care givers among other external partners. This is intended to improve planning of the discharge and information transfer especially where a patient is referred to a ‘senior hospital’.
2. b) Improved care of patients with chronic conditions like diabetes and Congestive Heart Failure. This will be achieved through the implementation of evidence based population care model like the inpatient-outpatient components for such conditions. The set standards must be adhered to.

The assessment at the strategic level will be done by assessing the rise in the number of the enrollment of the CHF and COPD.   The number is expected to rise by 25% for patients with high risk at the end of the financial year 2018/19. The care transition should be implemented by the end of the same year. At the program and unit level, indicators will be the readmission in a span of 30 days for the picked volumes of CMGs and measure of the vital long-term conditions.

Plan Implementation

The implementation of this quality improvement plan will involve all the stakeholders involved in the health care provision. The stakeholders include the policy makers, the hospital management of the hospital, the patients and the patients’ family. Most of the approaches and methods of quality improvement being used today were developed in other industries that are not related to health care provision. However, they have adopted by the health care industry nearly for 30 years now. Unfortunately, the approaches and methods have not been fully embedded into the health despite being adopted nearly 30 years ago. This, in turn, has resulted in lack of a complete evidence based analysis of their effectiveness.  All the staffs are expected to adhere to the proposed implementation plan. The implementation of this plan is expected to spread across the financial year 2018/19. Assessment will be done after every quarter to establish if there is any progress being made. The progress refers to the improvement in the quality of service being provided to the patients. In establishing this improvement, we will use the PDSA cycle i.e. the Plan-Do- Study-Act. PDSA was first developed by Dermin in 1982 and gives a four model for a continuous implementation of the improvement of patient safety improvement initiatives. The model can be used in the following instance:

• When a new quality improvement plan is being started.
• When there is a redesign or an improvement on the existing healthcare service
• When data collection and analysis plans are being developed to help in improving the service delivery. Today management is no longer an art but a science where management decisions are driven and influenced by the available data.

Cost-effects implementing patient safety initiatives. For an effective implementation of the proposed patient safety initiative and changes, the hospital management will incur extra cost in leadership training for the staff especially the team leaders. Secondly, the management will have to additional health care staff to cover for the possible shortage to reduce the work load. All the staff will also be trained on the importance of having a team work. The implementation process will be under the leadership of the PDSA select team. Lack of funds and uncooperative members of staff are likely to be the major challenges in the implementation process. There is a likelihood of resistance for change at first. Training and employment of new additional staff might also be costly to the hospital management.

Compensation for the Executives and other staff

Performance-based compensation helps in driving accountability during the implementation of the quality improvement. It links the compensation to the achievement of the set target. There will only be compensation if the target is achieved. The executives and the staffs are thus motivated to ensure the set target is achieved. In addition, it enables the hospital to have a consistency in the performance incentives application and transparency in the whole process.  The table below provides a guideline how the compensation will be done.  It should be noted that the compensation is tied to the achievement of the set target. Part B:  Change Management Theory Change management (CM) refers to the “all approaches used to prepare and support individuals, teams, and organization” (Hayes, 2014) while making change within the organization. Additionally, it includes the change in use of resources, process in business, allocation of budget or any other change that has a significant influence on the operation of the organization or company (Bratton &Gold, 2012). Under Organization Change Management (OCM), we looked into the organization as a whole and what ought to be changed. In contrast, change management only refers to people and how they are affected by transition during the change within the organization. There are six change management theories according to Hills, Jones & Schilling (2014). The Classical theory put emphasis on structure and things like division of labor, the command its direction are considered.  The scientific method puts emphasis on the efficiency, productivity, time and maximum utilization of space. The bureaucratic system has a strong emphasis on the authority and the rules of the organization. Under this system, the employees are expected to strictly adhere to the rules and regulations of the organization as they are with no flexibility. Junior officers are required to get approval from their seniors before undertaking some responsibilities no matter how simple they might be. This system is very common with the government institutions. The Human Relation Management system is one that focuses on the human factors within the organization or company. The human factors include things such as motivation (both as individual and at group level.  The contingency theory mainly aims at first establishing the problem then a solution is created through management. The final theory is the system management theory. This theory mainly focuses on the interdependency and the complexity of the system. This is done through combining and analyzing all the components to determine their impact on the general productivity of the organization or company. The most important factors to consider while selecting the type of change includes: goal and strategies, system measurement, the sequence of the steps and finally the implementation of the desired organization changes. John Fisher and John Kotter have come up with models that can be used to evaluate and enhance the implementation process of the change in the organization.  In this section discusses the John M. Fisher’s Change Model. This model is appropriate since it promotes corporation among the staff during the implementation process. Fisher uses a Transition model to explain how people react to any change as discussed by McDowell et al (2013). Ideally, people are generally resistant to change since they prefer being in their current situation.  Fisher theory is based on the study that was done by Elisabeth Kubler-Ross. In the study, Elisabeth identified the stages of grief. From that study, Fisher identified eight stages that include; Anxiety, Happiness, Fear, Threat, Guilt, Depression, Gradual Acceptance and Moving Forward.  Different people have different speed of moving through the levels. The speed is influenced by different factors like an individual’s temperamental, prior experiences among others. The key areas that this model focuses on include the resistance to change in the early stage and working with people through change.

                Initial Resistance to change

Generally, people have negative reaction to change during the early stages since the change causes disruption in their operation. Another reason why people are most likely to have a negative reaction is the uncertainty that comes with the change. It is even worse when one has a bad experience with change. One might have lost his or her job in before due to changes that were adopted by that organization or company. Such experience causes fear to the individuals and influences their perception about change in general. Such individuals are likely to be reluctant in adopting the proposed changes. However, this can be overcome by having an efficient and timely communication to the staff that will be affected. Good communication makes them understand the need to have change and its benefits to them. In this case, the nurses and other physicians will be informed on why the Patient Safety Initiative Change is important to them. Benefits such having a reduced readmission rate of patients, reduced infection among others are beneficial to them since they will result in reduced work load. Reduced workload means there will be no fatigue.  In addition, the improvement in the quality of healthcare delivery will build their reputation as professionals thus building their resume. With effective communication, the fear will go away hence making them eager to adopt the proposed changes. Similarly, the training is likely to a motivating factor since it provides them with an opportunity for self-growth. However, the process should not be rushed as it can end up producing the exact opposite of the desired result. People must be given time to overcome fear without being rushed through the process.  There should only be a movement to the action when the whole team is ready for it.

Working with people through the change process

During the implementation process, there is a possibility of some of the staff remaining stuck in the past system by constantly denying that change is actually taking place. In order for the process to be successful, the whole team should move as a unit. It is thus necessary to involve every member of the team through the whole process. In the implementation of the Patient Safety Change Initiative, the PDSA select team will consist of the departmental heads of all the departments in the hospital. This creates a sense of inclusivity as all the staffs will feel represented. The head of departments will also be expected to communicate to their members on the progress and need for the change.

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