Data Analysis and Quality Improvement Initiative Proposal

Healthcare institutions rely on data to plan, implement, and evaluate quality improvement initiatives. Departments have variable data corresponding to their care and desired outcomes. Professionals in these departments analyze their data to determine opportunities for improvement to enhance the working conditions and patient outcomes.

Data Analysis and Quality Improvement Initiative Proposal

These quality improvement initiatives also rely on interprofessional collaboration for their successful implementation. Proper planning for communicating and collaborating with other healthcare professionals is thus integral. This essay analyzes Vila Health Hospice Care’s Adverse Events and Near Misses and proposes a quality improvement initiative to address the performance shortfalls.

Data Analysis to Determine Underlying Healthcare Issue(s)

The Vila Health Hospice Adverse Events and Near Misses data is the basis for the quality improvement proposal. Healthcare data is important as it validates hypotheses, helps measure staff and organizational performance and helps evaluate quality improvement initiatives. Data reveals underlying healthcare delivery problems and allows healthcare providers to rectify them.

Healthcare data also helps determine the effectiveness of existing policies in improving patient outcomes. Data also helps healthcare institution leaders to plan improvement and develop other policies and practice guidelines. The Vila Health Hospice data shows many individuals with fewer than 7 days in the hospice program. However, the number has decreased by four patients in the past year. The number data shows that individuals are enrolled in the program late into the development of their disease or age and thus do not benefit greatly from the program.

IPU admissions have drastically reduced by 20 patients in the past year. The data shows that patients are receiving better care and thus do not need IPU admissions. The number of patients with a pain level of more than 7 (on a scale of 0-10) has increased by four, meaning there is poor pain control among the hospice patients. Pain is an important aspect of hospice care because it affects patients’ comfort, the major goal in hospice care (Swami & Case, 2018). The number of patients with no symptomatic relief in 24 hours has also increased by nine.

The overall goal of hospice care is symptomatic relief and pain and stress management; thus, the metric shows that patients are not receiving adequate care/support. The major healthcare issue is the close patient assessment which might be lacking. The hospital staff should be adept at assessing and enrolling individuals in the program early, managing their symptoms, and controlling their pain.

The healthcare data shows a need for closer monitoring for better patient outcomes in the hospice care program. The organization contains strong electronic health records and computer systems available for all healthcare providers and can thus sustain process improvement to enhance better patient outcomes in the program.

Adverse Events or Near Misses to Factor in Outcomes and Recommendations

The nursing process is integral for patient assessment and management. Flaws in the process can be detrimental. A lack of thorough patient assessment can lead to improper patient diagnosis and missed opportunities for care. Nurses might rush to meet the organizational objectives (especially when there is a nursing staff shortage) and finish their tasks on time, making mistakes (Jachan et al., 2021).

These mistakes include prescribing overdose drugs and poor physical and risk assessments, leading to missed opportunities in patient care. These activities could lead to adverse events and near misses. Inadequate professionals’ knowledge is also a shortfall and could lead to inappropriate diagnosis and subsequent wrong management leading to poor outcomes and adverse events (Jachan et al., 2021). Thus, there is a need for staff support and monitoring.

More data on the specific management interventions, such as pain relief medications, is necessary. The data will help determine the specific patient response to these medications. Data on healthcare provider patients’ visits and their relationship to patient outcomes are also integral. The causes of IPU admission also need critical analysis and their causal-effect relationships for effective management. Pain assessment, alongside assessment of other vitals, is also integral in monitoring pain levels and their variations over time (de Castro et al., 2018).

These data sets will help get in-depth information that will inform quality improvement and promote better patient outcomes. The hospice care data requires more information on the number of patients who died from a cause of death other than the underlying condition. For example, cancer patients in the program can succumb to a fall or take lethal higher doses. The information will provide more accurate information on the effectiveness of the hospice program.

The desired outcomes in preventing the adverse events are decreased patient admission in IPU, improved care provider assistance and patient monitoring, and longer stays in the hospice care program. The adverse events will decrease the need for critical care in the IPU because patient changes are detected early and appropriately managed. The longer patient stays in the hospice program means patients have a better chance at life with improved life quality and better outcomes.

The metrics requiring quality improvement initiative are pain levels above 7 in 24 hours and inadequate symptom relief within 24 hours. These metrics have deteriorated in the past year, with more patients reporting pain levels above 7 and others reporting inadequate symptom relief within 24 hours.

According to Swami and Case (2021), pain and symptom management are the overarching goals of hospice care. Other interventions such as counseling, medical care, personal care, and end-of-life are important but are considered after pain and symptom relief (Merchandante et al., 2018). Swami and Case (2021) emphasize that the goal is to improve the quality of life and comfort, not heal the patient.

Thus, poor symptom relief and pain management show the poor performance of the hospice care program and necessitate quality improvement initiatives. They require a keen analysis of the current pain and symptom management interventions, frequency, and patient differences.

The Proposed Quality Improvement Initiative(s0

The government and non-governmental bodies set forth policies for pain management in hospice care. These policies include opioid use in treating cancer pain, the WHO pain management ladder, and State Pian Policy Development. These policies aim to relieve the burden of laws and policies affecting pain management. The healthcare research and quality agency indicates the benchmarks and outcome measures aligned to pain and symptom relief in hospice care.

They include effectiveness, patient-centeredness, timeliness, and descriptive measures. They evaluate the families’ perception of the effectiveness, timeliness, and the program’s ability to meet patient needs (AHRQ, n.d.). The descriptive measures assess the readiness of hospice care programs regarding resources, personnel, and linkage to external resources.

The hospital trains its staff on extensive patient assessment and pain and symptom relief in hospice care. The hospital also trains them on safe prescription practices, including alternating opioids and other medication to prevent tolerance and dependence. The major problem affecting its effectiveness is poor staff support and monitoring offered in palliative care. There is a lack of organizational policies that ensure adequate patient assessment and prescription practices.

According to Schulz et al. (2022), staff support and monitoring increase their performance and eliminate shortfalls associated with malpractices. Staff fulfills all requirements after learning they are being observed and accountable for their practices. Thus, control and support are the lacking aspects that make the quality initiative ineffective.

The national QI initiatives require comprehensive patient assessment and pharmacologic and non-pharmacologic pain management interventions. Quality initiatives in other healthcare institutions include telehealth, accountability technologies, and patient assessment tools that guide staff in patient assessment (Kav et al., 2018). Other institutions use clinical decision support systems to help staff make the right care decisions in managing their patients. These quality improvement initiatives have improved patient outcomes in hospice care programs.

The areas for improvement identified earlier are staff support and monitoring in care delivery for comprehensive and prompt patient assessment and symptom management. Quality improvement initiatives in these areas will help staff consult when they encounter patient needs requiring more attention than routine care. They will also improve reporting and staff efforts in improving patient outcomes.

The proposed strategies to improve quality care and outcomes are video conferencing and clinical decision support systems (CDSS). Video conferencing will help with timely consultation and increased access to more complex care hence better patient outcomes. The clinical decision support systems will help improve the quality and effectiveness of care decisions.

The clinical decision support systems showcase blind spots in care provision and help providers select the most appropriate diagnosis and interventions, hence patient-centered care. Van der Stap et al. (2021) show that CDSS help combines symptom assessment scales and guideline-based recommendations to improve pain and symptom relief. These interventions will improve staff support and monitoring, thus promoting better performance and outcomes of the hospice program.

Information on how the organization ensures the accuracy of data entered and that nurses literacy visits patients in their homes (responsibility) is unavailable. The information could help improve the proposed initiatives by ensuring all available gaps are duly filled. The total number of patients in the program is also unavailable and could be useful in determining the problem’s severity and the resources required to implement these QIs.

Implementing the QI initiatives can pose various challenges. The initiatives will stretch the healthcare resources by purchasing computers and facilitating CDSS and video conferencing. In addition, there will be a need for available healthcare professionals to respond to the calls by the field healthcare providers. Care collaboration and coordination will thus be integral for the QI’s success.

There will also be an increased workload on healthcare professionals. Field healthcare workers will be assigned other professionals responsible for monitoring and verifying their data, increasing the already high workload. Thus, there might be a need to hire new employees for the program’s success and efficient implementation of the QI initiatives.

Quality Improvement Proposal and Interdisciplinary Team Inputs

Professionals have varying roles in the implementation of the QI initiatives. Nurses are the professionals on the ground and will enter data and utilize the CDSS to make informed decisions. Advanced practice registered nurses and doctors will be integral for consultation and support of the nurses in the field. The quality assurance department and healthcare and nursing informaticists will analyze the data collected and report on the performance of the hospice program.

The human resources department will monitor nurses’ performance and implementation of the initiatives and prepare reports. The healthcare leaders, such as the nurse manager, the head of the hospice program, and the hospital chief executive officer, will then make decisions regarding the continuity of the program. All these professionals will work together to ensure the success of the initiatives.

Timely communication of the specific roles of each professional will ensure they all promptly understand and perform their roles. Training professionals through simulations and physical lessons on interprofessional collaboration and their specific roles will also enhance their buy-in (Sanborn et al., 2020). A pre-implementation meeting and an internal memo on the same information will ensure professionals play their roles.

During these meetings, the professionals will be involved in decision-making to increase their participation and ownership of the program. According to Schot et al. (2020), professionals feel important and appreciated when making vital decisions for an institution. The project’s outcomes will help determine the effectiveness of the CDSS pain and symptom relief. The outcome data of interest includes data on the effectiveness of pain and symptom relief in 24 hours which will help determine the effectiveness of the CDSS and video conferencing consultation activities. The number of patients assessed for pain and symptom control each day will be assessed to determine the effectiveness of staff monitoring.

The proposed interventions will increase the workload of healthcare professionals. The added roles are rather few and will also increase the professional’s collaboration and interaction hence better work-life quality. Professional interaction increases job satisfaction and the respect professionals have for each other because each professional is vital and plays a crucial role in the team’s success (Labrague et al., 2022).

The proposed strategies will increase healthcare efficiency and promote better patient outcomes. All professionals will participate in care delivery, and better patient performance translates to better results in performance appraisal. Better patient outcomes increase job satisfaction and staff morale hence better productivity. Thus, the proposed QI will positively impact the healthcare professionals’ work-life quality.

Communication Strategies to Improve the Quality Improvement Initiatives

Open and free communication is integral to promoting the success of the QI initiative. Using multiple media and technologies for communication will improve professional understanding and help gain the professionals’ buy-in (Aceto et al., 2018). Communication will entail PowerPoint presentations, staff updates through listservs, email, and internal memos.

These communication channels will help emphasize the importance and understanding of the QI and thus increasing professionals’ buy-in. According to Hussain et al. (2018), presenting data to back claims and utilizing persuasion skills helps gain professionals’ buy-in. Healthcare professionals readily accept QIs backed up by data more than QIs with no data evidence.

Another strategy is shared decision-making. All the healthcare providers will be involved in decision-making, and all their perspectives will be collected from their feedback and analyzed. Workable ideas will be implemented to improve the initiatives’ outcomes.

The SBAR communication model is an important tool in healthcare communication. The information in all channels involved will utilize the model. The first step will entail informing professionals of the current situation using the available data. The step will also provide evidence of the need for a quality improvement initiative.

The second step, background, will entail current initiatives and their reasons for failure or underperformance (Lo et al., 2021). The third step will help explain the shortfalls’ causes and areas that require improvement- results of healthcare data and nursing process analysis. The last step, recommendation, will help present the quality initiative interventions (video conferencing and CDSS) to the healthcare professionals.

Conclusion

The hospice program data reveals major shortfalls in pain management and symptomatic relief. The major goals of hospice care are pain management and symptom relief to improve comfort; thus, the shortfalls are vital. Analyzing the problem reveals a lack of nurses’ support and monitoring when assessing patients. Thus, video conferencing and clinical decision support systems are the best interventions to increase nurses’ support and monitoring to ensure nurses deliver the care required for these patients in hospice care.

Involving the professionals in the decision-making processes of the QI and using multimedia to communicate the QI will boost its understanding and increases professionals’ buy-in. The ISBAR communication model will help enhance the communication process.

References

  • Aceto, G., Persico, V., & Pescapé, A. (2018). The role of Information and Communication Technologies in healthcare: taxonomies, perspectives, and challenges. Journal of Network and Computer Applications, 107, 125-154. https://doi.org/10.1016/j.jnca.2018.02.008
  • de Castro, C. C., Pereira, A. K. D. S., & Bastos, B. R. (2018). Implementation of the Evaluation Of Pain As The Fifth Vital Sign. Journal of Nursing UFPE/Revista de Enfermagem UFPE12(11).
  • Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002
  • Jachan, D. E., Müller‐Werdan, U., & Lahmann, N. A. (2021). Patient safety. Factors for and perceived consequences of nursing errors by nursing staff in home care services. Nursing Open8(2), 755-765. https://doi.org/10.1002/nop2.678
  • Kav, S., Brant, J. M., & Mushani, T. (2018, August). Perspectives in international palliative care. In Seminars in Oncology Nursing (Vol. 34, No. 3, pp. 284-293). WB Saunders. https://doi.org/10.1016/j.soncn.2018.06.009
  • Labrague, L. J., Al Sabei, S., Al Rawajfah, O., AbuAlRub, R., & Burney, I. (2022). Interprofessional collaboration as a mediator in the relationship between nurse work environment, patient safety outcomes and job satisfaction among nurses. Journal of Nursing Management30(1), 268-278. https://doi.org/10.1111/jonm.13491
  • Lo, L., Rotteau, L., & Shojania, K. (2021). Can SBAR be implemented with high fidelity and does it improve communication between healthcare workers? A systematic review. BMJ Open11(12), e055247. http://dx.doi.org/10.1136/bmjopen-2021-055247
  • Mercadante, S., Gregoretti, C., & Cortegiani, A. (2018). Palliative care in intensive care units: why, where, what, who, when, how. BMC Anesthesiology, 18(1), 1-6. https://doi.org/10.1186/s12871-018-0574-9
  • Sanborn, H., Cole, J., Kennedy, T., & Saewert, K. J. (2019). Practicing interprofessional communication competencies with health profession learners in a palliative care virtual simulation: A curricular short report. Journal of Interprofessional Education & Practice15, 48-54. https://doi.org/10.1016/j.xjep.2019.01.010
  • Schot, E., Tummers, L., & Noordegraaf, M. (2020). Working on working together. A systematic review on how healthcare professionals contribute to interprofessional collaboration. Journal of Interprofessional Care34(3), 332-342. https://doi.org/10.1080/13561820.2019.1636007
  • Schulz, J. H., Wilhelm Stanis, S. A., Li, C. J., Morgan, M., & Webb, E. B. (2022). Factors affecting staff support of a voluntary nonlead ammunition outreach program. Applied Environmental Education & Communication21(1), 55-72. https://doi.org/10.1080/1533015X.2021.1943062
  • Swami, M., & Case, A. A. (2018). Effective palliative care: what is involved? Oncology (08909091), 32(4).
  • van der Stap, L., de Heij, A. H., van der Heide, A., Reyners, A. K., & van der Linden, Y. M. (2021). Clinical decision support system to optimise symptom management in palliative medicine: focus group study. BMJ Supportive & Palliative Care. https://doi.org/10.1136/bmjspcare-2021-002940

Data Analysis and Quality Improvement Initiative Proposal Instructions

 Prepare an 8-10 page data analysis and quality improvement initiative proposal based on a health issue of interest. Include internal and external benchmark data, evidence-based recommendations to improve health care quality and safety, and communication strategies to gain buy-in from all interprofessional team members responsible for implementing the initiative.

Introduction
Health care providers are perpetually striving to improve care quality and patient safety. To accomplish enhanced care, outcomes need to be measured. Next, data measures must be validated. Measurement and validation of information support performance improvement. Health care providers must focus attention on evidence-based best practices to improve patient outcomes.

Health informatics, along with new and improved technologies and procedures, are at the core of all quality improvement initiatives. Data analysis begins with provider documentation, researched process improvement models, and recognized quality benchmarks. All of these items work together to improve patient outcomes. Professional nurses must be able to interpret and communicate dashboard information that displays critical care metrics and outcomes along with data collected from the care delivery process.

For this assessment, use your current role or assume a role you hope to have. You will develop a quality improvement (QI) initiative proposal based on a health issue of professional interest. To create this proposal, analyze a health care facility’s dashboard metrics and external benchmark data. Include evidence-based recommendations to improve health care quality and safety relating to your selected issue. Successful QI initiatives depend on the support of nursing staff and other members of the interprofessional team. As a result, a key aspect of your proposal will be the communication strategies you plan to use to get buy-in from these team members.

Preparation
To develop the QI initiative proposal required for this assessment, you must analyze a health care facility’s dashboard metrics. Choose Option 1 or 2 according to your ability to access dashboard metrics for a QI initiative proposal.

Option 1
If you have access to dashboard metrics related to a QI initiative proposal of interest to you, complete the following:

Analyze data from the health care facility to identify a health care issue or area of concern. You will need access to reports and data related to care quality and patient safety. For example, in a hospital setting, you would contact the quality management department to obtain the needed data. It is your responsibility to determine the appropriate resource to provide the necessary data in your chosen health care setting. If you need help determining how to obtain the needed information, consult your faculty member for guidance.
Include in your proposal basic information about the health care setting, size, and specific type of care delivery related to the identified topic. Please abide by Health Insurance Portability and Accountability Act (HIPAA) compliance standards.
Option 2
If you do not have access to a dashboard or metrics related to a QI initiative proposal:

Use the hospital data set provided in Vila Health: Data Analysis. You will analyze data to identify a health care issue or area of concern.
Include in your proposal basic information about the health care setting, size, and specific type of care delivery related to the identified topic.
Instructions
Use your current role or assume a role you would like to have. Choose a quality improvement initiative of professional interest to you. Your current organization is probably working on quality improvement initiatives that can be evaluated, so consider starting there.

To develop your proposal you will:

Gather internal and external benchmark data on the subject of your quality improvement initiative proposal.
Analyze data you have collected.
Make evidence-based recommendations about how to improve health care quality and safety relating to your chosen issue.
Remember, your initiative’s success depends on the interprofessional team\'s commitment to the QI initiative. Think carefully about these stakeholders and how you plan to include them in the process, as they will help you develop and implement ideas and sustain outcomes. Also, remember how important external stakeholders, such as patients and other health care delivery organizations, are to the process. As you are preparing this assessment, consider carefully the communication strategies you will employ to include the perspectives of all internal and external stakeholders in your proposal.

The following numbered points correspond to grading criteria in the scoring guide. The bullets below each grading criterion further delineate tasks to fulfill the assessment requirements. Be sure that your proposal addresses all of the content below. You may also want to read the scoring guide to better understand the performance levels related to each grading criterion.

Analyze data to identify a health care issue or area of concern.
Identify the type of data you are analyzing from your institution or from the Vila Health activity.
Explain why data matters. What does data show related to outcomes?
Analyze the dashboard metrics. What else could the organization measure to enhance knowledge?
Present dashboard metrics related to the selected issue that are critical to evaluating outcomes.
Assess the institutional ability to sustain processes or outcomes.
Evaluate data quality and its implications for outcomes.&
Determine whether any adverse event or near-miss data needs to be factored in to outcomes and recommendations.
Examine the nursing process for variations or performance failures that could lead to an adverse event or near miss.
Identify trends, measures, and information needed to critically analyze specific outcomes.
Specify desired outcomes related to prevention of adverse events and near misses.
Analyze which metrics indicate future quality improvement opportunities.
Develop a QI initiative proposal based on a selected health issue and supporting data analysis.
Determine benchmarks aligned to existing QI initiatives set by local, state, or federal health care policies or laws.
Identify any internal existing QI initiatives in your practice setting or organization related to the selected issue. Explain why they are insufficient.
Evaluate external national or international QI initiatives on the selected health issue with existing quality indicators from other facilities, government agencies, and nongovernmental bodies on quality improvement.
Define target areas for improvement and the processes to be modified to improve outcomes.
Propose evidence-based strategies to improve quality.
Analyze challenges that meeting prescribed benchmarks can pose for a health care organization and the interprofessional team.
Communicate QI initiative proposal based on interdisciplinary team input to improve patient safety and quality outcomes and work-life quality.
Define interprofessional roles and responsibilities relating to data and the QI initiative.
Explain how to ensure all relevant interprofessional roles are fully engaged in this effort.
Identify how outcomes will be measured and data used to inform interprofessional team performance related to specific tasks.
Reflect on the impact of the proposed initiative on work-life quality of the interprofessional team.
Describe how the initiative enhances work-life quality due to improved strategies supporting efficiency.
Determine communication strategies to promote quality improvement of interprofessional care.
Identify interprofessional communication strategies that will help to promote and ensure the success of the QI initiative.
Identify communication models, such as SBAR and CUS, to include in your proposal.
SBAR stands for Situation, Background, Assessment, Recommendation.
CUS stands for \"I am Concerned about my resident\'s condition; I am Uncomfortable with my resident\'s condition; I believe the Safety of the resident is at risk.\"
Consult this resource for additional information about these fundamental evidence-based tools to improve interprofessional team communication for patient handoffs:
Agency for Healthcare Research and Quality (AHRQ). (n.d.). Module 2: Communicating change in a resident’s condition. https://www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/ptsafety/ltcmod2ap.html
Communicate QI initiative proposal in a professional, effective manner, writing clearly and logically, with correct use of grammar, punctuation, and spelling.
Integrate relevant sources to support arguments, correctly formatting citations and references using APA style.
Example Assessment: Refer to QI Initiative Proposal Exemplar [PDF] for an idea of what an assessment given a proficient or higher rating on the scoring guide would look like.

Additional Requirements
Submission length: 8-10 typed, double-spaced pages of content plus title and reference pages.
Font: Times New Roman, 12 point.
Number of references: Cite a minimum of five current scholarly and/or authoritative sources to support your QI initiative proposal. Current means no older than 5 years unless a seminal work.
APA formatting: Citations and references need to adhere to APA style and formatting guidelines. Consult these resources for an APA refresher:
Evidence and APA.
APA Module.
American Psychological Association. (n.d.). APA style. https://www.apastyle.org/
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

Competency 1: Plan quality improvement initiatives in response to adverse events and near-miss analyses.
Determine whether any adverse event or near-miss data must be factored in to outcomes and recommendations.
Competency 2: Plan quality improvement initiatives in response to routine data surveillance.
Develop a QI initiative proposal based on a selected health issue and supporting data analysis.
Competency 3: Evaluate quality improvement initiatives using sensitive and sound outcome measures.
Analyze data to identify a health care issue or area of concern.
Competency 4: Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work life quality.
Communicate QI initiative proposal, based on interdisciplinary team input, to improve patient safety and quality outcomes and work-life quality.
Competency 5: Apply effective communication strategies to promote quality improvement of interprofessional care.
Integrate relevant sources to support arguments, correctly formatting citations and references using APA style.
Determine evidence-based communication strategies to promote quality improvement of interprofessional care.
Communicate QI initiative proposal in a professional, effective manner, writing clearly and logically, with correct use of grammar, punctuation, and spelling.