Tools And Methods For Quality Improvement Analysis

The nurse is challenged with the care of patients over a lifespan. Each stage of life brings its own physical and emotional changes which directs the care needs. The care needs of the pediatric patient will be much different from the needs of the geriatric population. The geriatric population has very specific needs which has prompted the government to establish the Quality Assurance & Performance Improvement (QAPI) program. The QAPI provides the framework for nursing facilities to develop and implement changes which address deficiencies the facility was found to have. Also, the QAPI program requires practices and policy be put in place to monitor care of the residents. The purpose of this paper is to list some of the changes the elderly go through as they age, and demonstrate these changes in a quality improvement project. After review of literature, I will discuss the challenges, barriers, and solutions as related to quality improvement. Lastly, I will discuss the quality of care for the geriatric in the future.

Quality improvement data is followed in all health care setting. The use of Cerner EHRs allows data to be obtained from patient charts to analyze core measures. According to the joint commission influenza and pneumococcal vaccinations measures should be addressed in all hospital in-patients (The Joint Commission, 2015). Data can be retrieved on those patient who were diagnosed with pneumonia to determine if they received the vaccinations for pneumonia and influenza. As well as tracking the time frame between diagnosis and treatment, and additionally the patient outcome. This is captured through the documentation of the clinical staff. The information can be analyzed to determine the quality improvement changes that need to be implemented to improve patient outcomes.

Falls are a major cause of injury and death in the frail older population with Alzheimer’s disease. Residents in the long-term care settings experience falls for many reasons and are likely to endure injuries more than those in other settings. Preventing falls in this setting posed significant challenge, many have cognitive problems, aged related changes, chronic medical conditions, medication effects, and physical limitations requiring dedicated interdisciplinary efforts (Vance, 2011).

Due to ineffective management systems, inefficiency is increasing, which often leads to congested emergency rooms, customer complaints, and lost revenue. Over the past seven years, Six Sigma concepts are increasingly being implemented in the healthcare industry. Despite the challenges of adopting these concepts, the healthcare industry uses them to improve services rendered quality, increase efficiency and reduce fatal human errors. Primarily because Six Sigma is based on a comprehensive approach on improving the human and transactional aspects of the process (human performance and task completion). In the case of JPS, the factors that determine quality and efficiency are the flow of information and interaction with the patients. Using the Six Sigma DMAIC process improvement approach, JPS Emergency Department should be able to streamline information flow and achieve strategic business results (p.

Physicians are faced with competitive practice environments that challenge their financial survival. The application of Lean Six Sigma, as you stated, is important to improving care, reducing costs, and ensuring sustainability of physicians practice. Medical practices have changed over the years as more physicians are seeking higher levels of practice security as payers change reimbursement models. Reimbursement models have changed from payment for each service rendered to the patient to fixed payments for all of the care required for a specific procedure or episode of care, and fixed payment for all the care required by a population of patients for a period of time. Income growth can no longer be achieved by seeing more patients but on value

After the interview with my nurse manager, I came up with the PICO question which states: “Does the computerized physician order entry (CPOE) system reduce the number of medication errors compared to the common paper system being used today?” This question is important and I selected it because the population that the Belvoir Community hospital serves includes army officers of all ages both active and retired including their spouses and children. This group includes two sub groups of highly vulnerable persons which include the very young and the very old, who have a high-risk effect for medication errors because the potential adverse drug event is three times greater than an adult hospitalized patient (Levine et al., 2001). CPOE is not a panacea, but it does represent an effective tool for bringing real-time, evidence-based decision support to physicians. Nurses are the last defense level of protection against medication errors, and are solely responsible for the dispensing, administering, and monitoring of medications. In healthcare, computers can be used to help facilitate clear and accurate communication between health care professionals. When using a CPOE system it allows physicians to type in prescriptions right into the device or computer which significantly lessens any mistakes that can occur when

Quality improvement (QI) is a process that includes incessant monitoring and assessment of current practices in order to avert potential errors and to increase the quality of delivered care (Folse, 2014). The programs associated with QI generally utilize available data to develop systems that focus on improving patient outcomes (Dunefsky & Kearney-Nunnery, 2012). Moreover, unlike the QA team, who identifies errors and devises individual corrective action plans; the QI team identifies the needs of patients and draws on problems to formulate a plan to improve the entire system.

A quantitative study conducted by Lifvergren, Gremyr, Hellstrom, Chakhunashvili, and Bergman (2010) analyzed the experiences and from a hospital group during a three-year period after the introduction of Six Sigma. It reports on 22 large Six Sigma improvement projects, their results and influence on other improvement activities. The study shows that 75% of the completed projects reached their goals within 18 months. The average net cost savings per completed project/year was $55,300. Overall, the results showed that Six Sigma is a useful concept when trying to improve healthcare processes. They recommend that Six Sigma should be an addition to the improvement practices used in healthcare development initiatives. It was also observed that the Six Sigma program can create much organizational pull regarding quality management and improvement efforts if teamwork is applied.

At UB's Center of Excellence for Global Enterprise Management, Li Lin, Ph.D., professor of industrial engineering, and his colleagues apply industrial-engineering tools, including Six Sigma and other lean enterprise methodologies originally developed for manufacturing processes, to improve the operations and competitiveness of hospitals.

Hospitals employ different approaches and models of CQI, such as Lean, Six Sigma and the Plan Do-Study Act model for improvement.

When discussing appropriate use of resources to improve the health of both individuals and the entire population, it is necessary to include terms like healthcare quality, effectiveness, and efficiency. According to the IOM, healthcare quality is defined as the degree to which health care procedures for individuals or populations increase the desired health outcomes and are consistent with the current professional knowledge. Quality should achieve similar outcomes for both individuals and the population of a given location. Quality can be categorized by structural elements, processes, and outcomes for metric evaluation. Structural elements include the material and labor utilized by an organization, and processes involve the delivery of

However, there is lack of understanding of how to implement a manufacturing improvement concept to a service oriented industry. Although there is strong evidence that, when properly applied, Lean can provided marked improvement in a healthcare setting. These improvements are tied to a strong commitment from the leadership to provide clear and concise guidance, goals, benchmarks, and to motivate the staff beyond the “bandwagon effect” by providing positive feedback and timely assessments of the effect of the new processes and protocols.

The healthcare industry needs systematic innovation initiatives in order to remain cost-efficient, competitive, and up-to-date just like any other service operation. Lean/six sigma is one of the methods that can be used to provide an efficient framework for generating innovation efforts in the healthcare industry. Some of the benefits associated with this approach include improving the quality of care services, controlling healthcare cost increases, and providing improved care services. The lean/six sigma approach is an important method for promoting quality in healthcare, especially with the alarming and unsustainable increase in the costs of medical care across the globe.

Robust parameter design (RPD), an effective quality improvement tool, minimizes the performance variability and bias of a product or a process in which the experimental design space is subject to physical restrictions and constraints. For a number of practical situations, optimal design criteria may allow best experimental design schemes to be generated based on the decision maker’s choices and the use of optimal design criteria to RPD problems may overcome the limitations of standard experimental designs in finding optimal operating conditions for both quantitative and qualitative input variables.

Today, the major predicament faced by pharmaceutical and medical device companies is the need for expediting the drug or device development cycle in order to place their product in the market at the prime time to attain market success. The process for such realization requires streamlining of efficiency at every stage of the process right from research and development, clinical research, regulatory compliance, production, sales, and marketing. Incorporation of Lean Six Sigma without prior streamlining and optimization of the process will limit the opportunity to benefit from the speed and robustness that the technology proposes. The dearth of theoretical and empirical evidence on the applicability of Lean Six Sigma technology in research conducted by medical device and pharmaceutical companies led to this position paper to present the proficiency of this technology with real-time illustrations.