DISCUSSION: Using Improvement Science Models to Promote Quality and Safety while all changes do not lead to improvement, all improvement requires change.

-United States Agency for International Development

Improvement science models bring together research and evidence-based practice to identify the most effective ways to promote quality and safety in health care. As a central tenet of quality improvement, attention must be paid to the processes that contribute to outcomes.

In this Discussion, you examine quality improvement models and evaluate how they could be applied to address specific issues within health care organizations.

To prepare:

· Review the improvement models presented in the Learning Resources.

· Evaluate each of the models and select two on which to focus for this Discussion.

· Consider how each of the two models could be utilized in a health care organization to promote quality and safety. Think about the following:

o How does the model bring together research and evidence-based practice to facilitate quality improvement?

o How does the model contribute to a culture of quality and safety?

o How does it address changes in process?

· Reflect on the quality improvement issue and the health care setting that you are addressing for your Course Project. Of the two models that you have selected, determine which one you, as a nurse leader-manager, would use to address this issue. Also consider how this would relate to one or more of the IOM's six aims for quality and safety.

Post on or before day 3 your analysis of how the two improvement models that you selected could foster a culture of quality and patient safety and facilitate changes in process that promote positive outcomes. Explain how you would use one of these models to address the quality improvement issue in the organization that you have selected for your Course Project, and how doing so would relate to one or more of the IOM's six aims for improving quality and safety.

PROJECT: Section 3: Quality Measurement and Assessment

This week you continue working on Section 3 of your Course Project, which was introduced in Week 6. Through your work in previous weeks of this course, you have likely gained critical insights into the organization that serves as the focus for your quality improvement plan. Integrating this knowledge of the organization into your plan for addressing a quality improvement issue is essential for successfully facilitating change.

As you deepen your analysis of your selected organization, consider how the information presented in this week's Learning Resources relates to strategic priorities as well as to the uniquely collaborative and competitive dynamic that binds organizations in health care.

To prepare:

· Think about the quality improvement issue that you are addressing and the associated plan that you are developing. Consider the following:

o What is the overall purpose, or aim, of doing this work?

o What would you hope to achieve for the organization by undertaking this project? What are the objectives of this initiative?

o What value would this work add to the organization?

o How would this work improve practice and create outcomes with impact?

· Review Chapter 7 of the Sadeghi, Barzi, Mikhail, and Shabot course text. Consider how addressing this quality improvement issue would align with the organization's mission, vision, values, and strategic goals and objectives. How does it relate to regulatory issues, and other matters that are significant for the organization? If you notice a misalignment, use this as an opportunity to refine your focus.

· With this in mind, continue to hone your development of this Assignment, integrating the concepts addressed here into Section 3.

To complete:

Write a 3- to 5-page paper that includes:

· An introduction to your quality improvement plan, including the overarching aim of this initiative and an explanation of how it aligns with the mission, vision, values, and strategic goals and objectives of the organization, as well as regulatory issues and other matters that are significant for the organization

· An overview of the current situation with regard to this quality improvement issue in the organization

· A description of measures and indicators

· A presentation on data related to this issue, including:

o Actual historical and current data and/or a description of the methods that you would use to collect and analyze the data

o Methods for collecting and analyzing data in the future, including when you would do this

· A description of realistic, evidence-based targets

Be sure to cite evidence from the literature to justify your selection of the measures and indicators, as well as the performance targets. This section of the Course Project serves as the Portfolio Assignment for this course.

Section 4: Quality Improvement Strategies

Through your work on Section 3 of the Course Project, you have examined the gap between current performance and evidence-based targets and considered how addressing this gap relates to organizational priorities and large-scale aims for quality improvement.

In this section of the Course Project, you begin to think about quality improvement strategies that could help to bridge this gap. As noted in the Sadeghi, Barzi, Mikhail, and Shabot text, this is referred to as performance-driven planning.

Since the publication of the Institute of Medicine's report "Crossing the Quality Chasm," a good deal of attention has been paid to the need to examine processes that contribute to outcomes (Ernst, Wooldridge, Conway, Dressman, Weiland, Tucker, and Seid). As the USAID has noted, interventions "will not create the desired outcome to improve the quality of care unless the overall process of care delivery is also improved." Therefore, attention to process redesign is a central aspect of cultivating strategies for improvement.

To prepare:

· Refer to the modified Donabedian model (access, structure, process, outcome, and patient experience) presented in Chapter 9 of the Sadeghi, Barzi, Mikhail, and Shabot text.

· Recall the performance targets that you identified for Section 3. What does the recommendation that performance-driven planning should "begin with the end in mind" suggest given your established goals?

· Review the information presented in Chapter 9 of the Sadeghi, Barzi, Mikhail, and Shabot text, and think about how you would assess the organization's strengths and weaknesses related to the performance gaps you identified in Section 3.

· Based on the above, start to think of specific evidence-based strategies that could be implemented to close/minimize the performance gaps you have identified. Consider both interventions (what) and processes (how). Focus on strategies that are supported by the latest research and could create systems-level change. These may be tentative for now, but be sure to identify at least one that specifically lends itself to a change in process (i.e., practice, protocol, pathway, activity).

Additional instructions for Section 4 are presented next week. To complete this Assignment, you will create a process map and write a paper describing quality improvement strategies.

REMINDER: Course Project: Promoting Health Care Quality