Quality Initiatives at Penmen Hospital

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Quality Initiatives at Penmen Hospital

8-1 Project Two: Proposal

This proposal outlines the findings from the organizational assessment completed in Project One and recommendations to further quality initiatives (QI) at Penmen General Hospital (PGH). It also incorporates information technology and communication systems, collaboration strategies, policy and regulation considerations, ethical principles, and a plan for evaluation.

Findings Summary: 

The organizational assessment of Penmen General Hospital found a few areas for improvement, most related to patient safety, communication, and quality of care. A few significant findings are highlighted below.

  • Patient safety gaps: A few issues were observed that not only compromise patient safety but also pose potential threats related to medication administration, fall prevention, and infection control policies (Gross et al., 2023). The hospital implemented evidence-based practices poorly, which led to an increase in preventable errors.
  • Communications deficiencies: Poor communication among practitioners, particularly around shift changes and interdisciplinary collaboration. The most frequent kinds of adverse consequences of miscommunication were delays in care and inconsistent patient management (Kelen et al., 2021).
  • Technology use disruption: Poor utilization of hospital information technology (IT) systems was reflected in electronic health records (EHR) use; staff were undertrained, and system downtimes occurred frequently, causing interruptions in patient care and inefficiency in workflow.
  • Staffing issues: Severe shortages and high turnover were very significant problems; overworked nurses and a lack of supporting staff resulted in burnout and lower quality of care (ANA, 2021).
  • Quality of care concerns: The hospital’s quality measures indicated variability in care standards, with patient satisfaction scores being lower than average (Bartlett et al., 2023). Specifically, there was a need to improve care coordination and ensure consistent care delivery across different departments.
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  1. Recommendations: 

From the findings, the following are the quality initiatives recommended:

A. Patient safety and care quality

  • Implement fall prevention program: One of the leading causes of patient injury in the facility was falls. Equipping the facility with a comprehensive fall prevention program, complete with staff training on the subject matter, constant risk assessment, and changes in the environment, will aid in reducing the cases of injuries resulting from falls (ANA, 2021).
    Rationale: Literature indicates that hospitals with a standardized program to prevent falls significantly reduce injury from falls. Such a program would entail routine patient assessments and staff training in evidence-based guidelines for patient mobility.
  • Improve medication safety practices: This would result from standardization of medication administration practices by utilizing barcoding technology and ongoing audits. This practice would reduce medication errors as identified by IHI, 2020.

Rationale: Medication errors are among the top causes of preventable harm in care. Technology such as BCMA systems will enhance accuracy and help ensure that the right patient receives the right medication at the right dose.

  1. Enhance Communication and Team Coordination
  • Introduce structured handover tools: The standardized tools for communication at the time of shift change include SBAR, which stands for Situation-Background-Assessment-Recommendation, and it will ensure that at the time of communication, the critical information about the patient is conveyed correctly (IHI, 2020).
    Rationale: Structured communication tools have evidence-based practice showing that they decrease the rates of communication errors and improve patient safety during handoffs. Therefore, this strategy, SBAR, can support clear and concise communication amongst health professionals.
  • Establish interdisciplinary rounds: Regular interdisciplinary rounds with physicians, nurses, pharmacists, and other health professionals will enhance teamwork and improve coordination of care (IHI, 2020).
    Rationale: Collaborative rounding allows for a comprehensive approach in the care of the patient; it ensures that all issues concerning a patient’s treatment are brought to light and dealt with by the entire team. Besides, this approach has proven ways of ensuring better patient outcomes and higher levels of satisfaction among patients.
  1. Address Staffing and Workload Issues
  • Implement a nurse staffing matrix: A dynamic staffing matrix that modifies nurse-patient ratios according to acuity and workload will mitigate staffing issues.
    Rationale: Adequate staffing ensures high-quality care and prevents the burnout of health professionals. An active staffing matrix provides appropriate nurse assignments according to patients’ needs, developing staff satisfaction and patient outcomes (Gross et al., 2023).
  1. Information Technology and Communication Systems Considerations: 

Information technology and communication systems are two significant elements of the success of the proposed quality initiatives. For technology and communication systems to contribute to these improvements, the following needs to be considered:

  • Electronic Health Records (EHR) optimization: The hospital’s EHR system must be optimized for ease of use, ensuring full integration among departments. Staff training on the system should be provided for proficiency in documentation and care coordination (Kelen et al., 2021).
    Impact: Optimizing the EHR system will minimize documentation errors and ensure patient information is available to all relevant healthcare providers, thus improving care coordination.
  • Integration of telehealth: Telehealth should be integrated into the hospital’s remote consultation and follow-up care model, particularly for discharged patients who still need monitoring.
    Impact: Telehealth can reduce readmissions and improve patient satisfaction by providing convenient access to care without the need for in-person visits.
  • Communication systems: Secure real-time communications of clinicians through investments in instant messaging systems support quick decision-making and timeliness of care.
    Impact: Efficient communication systems reduce care delivery delays and enhance collaboration among healthcare providers, particularly in time-sensitive situations.
  1. Quality Improvement Considerations: 

The culture of safety and accountability will provide the key to achieving quality improvement. Commonly, it has been referred to as “Just Culture.” This concept designates an environment where staff can report errors or near misses without fear of punitive consequences. Components that will comprise such culture are:

  • Patient safety programs: As mentioned earlier, implementing programs like fall prevention and medication safety protocols will directly impact patient safety. A culture of free exchange of information about concerns will address precursors of adverse events early (AHRQ, 2021).
  • Just Culture: Just Culture balances accountability with learning from errors. Staff will be empowered to report incidents, which become opportunities for learning to understand the improvement needed in systems and processes (Gross et al., 2023).
  • Rationale: A Just Culture views errors as system failures rather than individual faults. Therefore, this approach means transparency and continuous improvement are the ideals of any culture.

    Collaboration Strategies

The success of a QI initiative depends on effective collaboration of stakeholders. The following strategies must be implemented:

  • Stakeholder engagement: Engage primary stakeholders such as leadership in hospitals, departmental heads, nursing staff, and patients themselves in the process of planning and implementation. There must be regular feedback sessions where concerns are being addressed and input on proposed changes would be received from them.
    Impact: Stakeholder engagement fosters ownership and collaboration in engaging these groups to achieve success with regard to the QI initiative.
  • Team collaboration: Multidisciplinary teams for each QI initiative will ensure that all aspects of patient care are considered. For example, the fall prevention program involves registered nurses, physical therapists, and facility management in policy and practice.
    Impact: The multidisciplinary collaboration will ensure a holistic approach toward patient care, hence yielding better outcomes.
  1. Policy and Regulation Considerations
    Several policy and regulatory considerations have to be taken into account in relation to the described quality initiatives:
  • Regulative compliance: Any initiated activity must align with the country’s ambitions on patients’ safety. For instance, an accrediting organization like The Joint Commission expects the medication safety program to be carried out to achieve the latter’s standards on minimizing medication errors (Kelen et al., 2021).
    Impact: Compliance with regulations and laws will enhance the hospital’s reputation and ensure that penalties for non-compliance are averted.
  • Financial support: Management should seek financial support for the upgrade of technology and training of staff. This means grant applications or shifting of budgetary resources to make the priority on patient safety and quality improvement initiatives.

    Impact: These initiatives would not be implemented without proper financial support, and more so on getting the right technology and training for the staff.

  1. Ethical and Safety Principles
    The recommendations below form a basis for ethical considerations of beneficence, non-maleficence, and respect for patient autonomy.
  • Beneficence and non-maleficence: The primary goal of the recommendations is to do good (beneficence) and prevent harm (non-maleficence). The fall prevention and medication safety programs must be embedded in a way that clearly improves the well-being of the patients and prevents them from suffering avoidable harm.
    Impact: Adhering to ethical principles ensures that patient safety remains the top priority in all QI initiatives.
  • Patient autonomy: Interdisciplinary rounds and structured communication tools also enhance patient autonomy through the involvement of patients and families in care decisions. This model is in concurrence with patient-centered care, a foundation of ethical healthcare.
    Impact: Engaging patients in active care for themselves promotes better patient satisfaction and improves health outcomes.

  1. Evaluation Planning: 

A detailed evaluation plan will be inculcated within an implementation framework to measure the efficacy of the recommendations proposed. The following modalities will be utilized in assessing the success of the quality initiatives:

  • Data monitoring: Key performance indicators (KPIs), such as fall rates and medication errors, will be tracked regularly (Blazin et al., 2020). The data will be retrieved from EHRs and incident reporting systems.
    Impact: Monitoring the KPIs enables the hospital to determine whether QI initiatives meet their goals and proves the lessons learned from the process for further improvements (Blazin et al., 2020).
  • Patient satisfaction surveys: Patients will be surveyed to provide feedback on how QI initiatives may have affected their perceptions of communication, safety, and quality of care (AHRQ, 2021).
    Impact: Patient feedback provides insight into how well QI initiatives work and highlights areas needing additional attention.
  • Staff feedback and training evaluations: Staff should be asked to provide regular feedback on how initiatives are being implemented and on the training delivered. Staff satisfaction levels and retention rates will also be monitored.
    Impact: Knowing the staff’s views on the initiatives ensures that any problems in implementation are solved, resulting in a more effective and friendly environment.

Generally, the proposed quality improvement initiatives aimed at improving patient safety, care quality, and staff collaboration by addressing identified organizational assessment findings at Penmen General Hospital. This may include implementing organized communication tools, optimizing staffing, and enhancing technology to ensure significant impacts on the provision of high-quality care in the hospital. Through careful planning, stakeholder engagement, and adherence to ethical principles, these initiatives can transform the hospital into a safer and more effective healthcare provider.

References

Agency for Healthcare Research and Quality (AHRQ). (2021). Strategies to improve communication between healthcare professionals. AHRQ. https://www.ahrq.gov/research/findings/factsheets/communication/comm-strategies/index.html

American Nurses Association (ANA). (2021). Nursing-sensitive indicators for patient safety and care quality. ANA. https://www.nursingworld.org/practice-policy/nursing-excellence/quality-and-safety/nursing-quality-indicators/

Bartlett, B. N., Cassidy, S. A., Geib, T. L., Johnson, W. A., Lanz, A. D., Linnemann, K. S., … & Vanhoudt, N. N. (2023, September). Implementation of a pediatric bed prioritization process in a rural Minnesota community-based hospital. In Healthcare (Vol. 11, No. 3, p. 100703). Elsevier.

Blazin, L. J., Sitthi-Amorn, J., Hoffman, J. M., & Burlison, J. D. (2020). Improving Patient Handoffs and Transitions through Adaptation and Implementation of I-PASS Across Multiple Handoff Settings. Pediatric quality & safety, 5(4), e323.

Gross, T. K., Lane, N. E., Timm, N. L., Conners, G. P., Gross, T., Hoffmann, J., … & committee on pediatric emergency medicine. (2023). Crowding in the emergency department: Challenges and recommendations for the care of children. Pediatrics, 151(3).

Institute for Healthcare Improvement (IHI). (2020). Improving communication during patient hand-offs. IHI. https://www.ihi.org/resources/Pages/Tools/Handoff-Communications-Toolkit.aspx

Kelen, G. D., Wolfe, R., D’Onofrio, G., Mills, A. M., Diercks, D., Stern, S. A., … & Sokolove, P. E. (2021). Emergency department crowding: the canary in the health care system. NEJM Catalyst Innovations in Care Delivery, 2(5).

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