Week 4: Tools and Project Management

How might project management lend itself to quality improvement in healthcare and nursing practice?

Project management is a systematic process used to achieve a specific goal utilizing a clear framework to initiate, plan, control, review, implement, and complete. This process provides for many checks and balances opportunities to ensure the goal is achieved and met following the guidelines outlined at the start of the project. Therefore, project management is useful to ensure quality improvement measures and methods are achieved following clear guidelines that address the scope and focus on an organization’s goal.

This week, you will consider the role of project management as it relates to a quality improvement practice gap. You will also continue your exploration of the importance of quality improvement methods and tools for nursing practice, as you complete your Assignment introduced in Week 3. As you consult this week’s Learning Resources, you will continue to consider the use of these tools in quality improvement and examine how these systems and methods could relate to your practice, organization, and overall experience in nursing practice.

Learning Objectives

Students will:

• Analyze quality improvement practice gaps
• Develop SMART objectives related to project management for a quality improvement practice gap
• Justify project management approaches to support projects addressing a quality improvement practice gap
• Analyze rate-based measures for nursing practice and healthcare delivery
• Analyze measurement systems and methods for rate-based measures
• Evaluate rate-based measure definitions, benchmarks, and comparisons related to organizational performance and metrics
• Apply rate-based measures to an organization or clinical setting
• Analyze the relationship between rate-based measures and organizational performance metrics for patient safety, healthcare quality, and cost of healthcare

Learning Resources

Required Readings (click to expand/reduce)

Required Media (click to expand/reduce)

https://academics.waldenu.edu/catalog/courses/nurs-1/8302

Assignment 1: Applying Project Management Approaches for a Quality Improvement Practice Gap

• Project management allows for a clear and focused workflow to approach an issue or task. These approaches streamline a process, allow for checks and balances, and ensure all stakeholders are active participants in the process. Project management approaches often utilize SMART objectives to define and set the objectives for the project.
• Photo Credit: Getty Images/iStockphoto

Each letter of the acronym SMART defines a different criterion for the objective. A SMART objective is specific, measurable, assignable, realistic, and timely. These objectives help to steer the work and direct the stakeholders to the completion of the project.

For this Assignment, you will reflect on project management approaches that could be used to address a quality improvement practice gap. You will develop SMART objectives for the planning and execution of a quality improvement project, and will consider potential project management approaches or activities that could be used in executing this project.

To Prepare:

• Review the Learning Resources for this week, and consider the approaches of project management.
• Refer to the Week 3 Discussion, and reflect on the quality improvement practice gap you identified.
• Consider how you might apply the project management approaches examined this week to address the quality improvement practice gap you identified.
• Think about how you might develop SMART objectives for the planning and execution of a project to address the quality improvement practice gap you identified.
• Consider any other project management approaches or activities you might recommend using for your project that will address the quality improvement practice gap you identified.

To address the quality improvement practice gap I identified in the Week 3 Discussion, focusing on the timely initiation of appropriate antibiotic therapy for septic patients in the emergency department (ED), I would apply project management approaches to ensure a clear and focused workflow. Utilizing SMART objectives will help define and guide the project towards successful completion.

Here are SMART objectives for planning and executing the project:

1. **Specific:** Develop evidence-based protocols and standardized order sets for the timely initiation of antibiotic therapy in septic patients presenting to the ED.

2. **Measurable:** Achieve a 20% improvement in the percentage of septic patients receiving antibiotics within 1 hour of ED presentation within six months of protocol implementation.

3. **Assignable:** Assign responsibility for protocol development, education and training, protocol implementation, and ongoing monitoring and evaluation to interdisciplinary team members, including emergency physicians, nurses, pharmacists, and quality improvement specialists.

4. **Realistic:** Ensure that the project objectives are feasible within the resources and constraints of the healthcare organization, considering factors such as staffing, budget, and available technology.

5. **Timely:** Implement the antibiotic initiation protocol within three months of project initiation and monitor progress towards achieving improvement targets on a monthly basis.

In addition to SMART objectives, I would recommend the following project management approaches or activities for executing this project:

**Interdisciplinary Team Collaboration:**

Establishing an interdisciplinary team comprising key stakeholders involved in sepsis care, including emergency physicians, nurses, pharmacists, and quality improvement specialists. Regular team meetings will facilitate collaboration, decision-making, and communication throughout the project.

**Quality Improvement Methodology:**

Utilizing a quality improvement methodology, such as the Plan-Do-Study-Act (PDSA) cycle, to guide the implementation of the antibiotic initiation protocol. This iterative approach allows for testing and refining interventions based on real-time feedback and data analysis.

**Change Management Strategies:**

Implementing change management strategies to promote staff engagement and buy-in for the new protocol. This may include providing education and training on sepsis recognition and management, addressing staff concerns and resistance to change, and celebrating successes and achievements throughout the project.

**Performance Monitoring and Feedback:**

Establishing mechanisms for ongoing performance monitoring and feedback to track progress towards achieving project objectives. This may involve regular data collection and analysis, performance dashboards, and feedback sessions with frontline staff to identify barriers and opportunities for improvement.

By applying project management approaches and developing SMART objectives, along with utilizing interdisciplinary collaboration, quality improvement methodology, change management strategies, and performance monitoring, I aim to effectively address the quality improvement practice gap and improve patient outcomes in sepsis management within the ED.

The Assignment: (2–3 pages)

• Briefly describe the quality improvement practice gap you identified in your nursing practice or organization. Be specific.
• Develop at least two SMART objectives you might apply in the project planning phase or execution phase to address the quality improvement practice gap you identified.
• Recommend at least two project management activities you would use for your project, addressing the quality improvement practice gap you identified. Explain your justification for why these activities would provide the best support. Be specific and provide examples.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

Title: Addressing the Quality Improvement Practice Gap in Timely Antibiotic Initiation for Septic Patients in the Emergency Department

Introduction:

In this paper, I will identify and address a quality improvement practice gap in my nursing practice related to the timely initiation of appropriate antibiotic therapy for septic patients in the emergency department (ED). I will develop SMART objectives and recommend project management activities to effectively address this gap.

Quality Improvement Practice Gap:

The quality improvement practice gap identified in my nursing practice is the delay in initiating appropriate antibiotic therapy for septic patients presenting to the ED. Despite the critical importance of timely antibiotic administration in improving sepsis outcomes, delays can occur due to factors such as diagnostic uncertainty, medication preparation time, and workflow inefficiencies. Addressing this gap is essential for improving patient outcomes and reducing morbidity and mortality associated with sepsis.

SMART Objectives:

1. Specific: Develop evidence-based protocols and standardized order sets for the timely initiation of antibiotic therapy in septic patients presenting to the ED.
2. Measurable: Achieve a 20% improvement in the percentage of septic patients receiving antibiotics within 1 hour of ED presentation within six months of protocol implementation.

Project Management Activities:

1. Interdisciplinary Team Collaboration: Establishing an interdisciplinary team comprising emergency physicians, nurses, pharmacists, and quality improvement specialists to develop and implement the antibiotic initiation protocol. Regular team meetings will facilitate collaboration, decision-making, and communication throughout the project. For example, the team can collaborate to review current practices, identify barriers to timely antibiotic initiation, and develop strategies for protocol implementation.

2. Quality Improvement Methodology: Utilizing a quality improvement methodology, such as the Plan-Do-Study-Act (PDSA) cycle, to guide the implementation of the antibiotic initiation protocol. This iterative approach allows for testing and refining interventions based on real-time feedback and data analysis. For instance, the team can use the PDSA cycle to pilot the protocol in a small-scale trial, evaluate its effectiveness, make adjustments as needed, and then implement it on a larger scale.

Conclusion:

Addressing the quality improvement practice gap in timely antibiotic initiation for septic patients in the ED requires the development of SMART objectives and the implementation of effective project management activities. By establishing evidence-based protocols, fostering interdisciplinary collaboration, and utilizing quality improvement methodologies, we can improve patient outcomes and enhance the overall quality of care delivery in the ED.

Week 4: Tools and Project Management

By Day 7

Submit your Assignment by Day 7 of Week 4.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK4Assgn1+last name+first initial.(extension)” as the name.
• Click the Week 4 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
• Click the Week 4 Assignment 1 You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer Find the document you saved as “WK4Assgn1+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 4 Assignment 1 Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 4 Assignment 1 draft and review the originality report.

Submit Your Assignment by Day 7 of Week 4

To participate in this Assignment:

Week 4 Assignment 1

Assignment 2: Tools for Measuring Quality

• How do we determine quality? Quality in other areas of our lives can be subjective, so how do we ensure—specifically as it relates to our nursing practice—that quality is clearly defined and measurable?
  Tools for measuring quality are used to assess the value measured, collected, or compared. These tools allow for subjectivity to be replaced with objectivity through data, formula, ranking, and analysis.
• Photo Credit: Getty Images/iStockphoto

For this Assignment, you will explore at least three rate-based measures of quality. You will deconstruct each measure to explore your understanding of the measure, its importance, and its impact on patient safety, cost of healthcare, and overall quality of healthcare.

To Prepare:

• Review the Learning Resources, for this week, and reflect on tools for measuring quality in nursing practice.
• Select three rate-based measurements of quality that you would like to focus on for this Assignment.
  • Note: These measurements must relate to some aspect of clinical or service quality that directly relates to patient care or the patient’s experience of care. For the purposes of this Assignment, an analysis of staffing levels is not
  • You can find useful information on quality indicators that are of interest to you on these websites and resources. You may choose only one of the three measures to be some form of patient satisfaction measure.
• Consider how the three rate-based measures (you will select) are defined, how the rates were determined or calculated, how the measures were collected, and how these measures are communicated to both internal and external stakeholders.
• Reflect on how the three rate-based measures (you will select) may relate to organizational goals for improved performance.
• Reflect on the three rate-based measures (you will select), and consider the importance of these measures on patient safety, cost of healthcare, and overall quality of healthcare.

Title: Exploring Rate-Based Measures of Quality in Nursing Practice

Introduction:

This paper will explore three rate-based measures of quality in nursing practice, focusing on their definitions, importance, and impact on patient safety, the cost of healthcare, and overall quality of healthcare.

Rate-Based Measures Selected:

1. Hospital-Acquired Infections (HAIs) Rate: This measure refers to the number of infections acquired by patients during their stay in a healthcare facility, such as central line-associated bloodstream infections (CLABSIs) or catheter-associated urinary tract infections (CAUTIs).

2. Readmission Rate: This measure calculates the percentage of patients who are readmitted to the hospital within a specified time frame, typically 30 days after discharge, for the same or related condition.

3. Patient Satisfaction Score: This measure assesses patients’ perceptions of the care they received during their hospital stay through surveys or questionnaires.

Definition and Importance:

1. HAIs Rate: The HAI rate is a critical indicator of patient safety and healthcare quality. High rates of HAIs can lead to increased morbidity, mortality, and healthcare costs, as well as prolonged hospital stays. Preventing HAIs is essential for ensuring patient safety and reducing the burden on healthcare resources.

2. Readmission Rate: The readmission rate reflects the effectiveness of care transitions and continuity of care processes. High readmission rates may indicate gaps in care coordination, inadequate discharge planning, or unresolved issues contributing to patients’ health problems. Reducing readmissions is important for improving patient outcomes and reducing healthcare expenditures.

3. Patient Satisfaction Score: Patient satisfaction scores provide insights into patients’ experiences of care, including communication with healthcare providers, pain management, and overall hospital environment. Positive patient experiences are associated with better treatment adherence, improved clinical outcomes, and higher patient retention rates.

Impact on Patient Safety, Cost of Healthcare, and Overall Quality of Healthcare:

1. HAIs Rate: High HAI rates can compromise patient safety by increasing the risk of healthcare-associated complications and adverse outcomes. In addition, HAIs contribute to rising healthcare costs through increased utilization of resources, such as additional treatments, longer hospital stays, and antibiotic resistance.

2. Readmission Rate: High readmission rates not only indicate potential gaps in care quality but also result in significant financial implications for healthcare organizations. Hospital readmissions incur additional costs, including reimbursement penalties under value-based payment models, and may reflect suboptimal care transitions and post-discharge management.

3. Patient Satisfaction Score: Positive patient satisfaction scores are associated with improved patient safety, as satisfied patients are more likely to engage in their care, adhere to treatment plans, and communicate effectively with healthcare providers. Moreover, satisfied patients are more likely to return to the same healthcare facility for future care, thereby contributing to higher patient retention rates and revenue generation.

Conclusion:

Rate-based measures of quality play a crucial role in assessing and improving healthcare outcomes, patient experiences, and organizational performance. By understanding the definitions, importance, and impact of measures such as HAIs rate, readmission rate, and patient satisfaction score, healthcare organizations can identify areas for improvement, implement targeted interventions, and ultimately enhance the quality and safety of patient care.

Week 4: Tools and Project Management

The Assignment: (8–10 pages)

• Describe the three rate-based measures of quality you selected, and explain why.
• Deconstruct each rate-based measure to include the following:
  • Describe the definition of the measure.
  • Explain the numerical description of how the measure is constructed (the numerator/denominator measure counts, the formula used to construct the rate, etc.).
  • Explain how the data for this measure are collected.
  • Describe how the measurement is compared externally to other like settings, and differentiate between the actual rate and a percentile ranking. Be specific.
  • Explain whether the measure is risk adjusted or not. If so, explain briefly how this is accomplished.
  • Describe how goals might be set for each measure in an aggressive organization, which is seeking to excel in the marketplace. Be specific and provide examples.
• Describe the importance of each rate-based measure to a chosen clinical organization and setting.
  • Using the websites and resources, you can choose a hospital, a nursing home, a home health agency, a dialysis center, a health plan, an outpatient clinic, or private office; a total population of patient types is also acceptable, but please be specific as to the setting. That is, if you are interested in patients with chronic illness across the continuum of care, you might home in a particular health plan, a multispecialty practice setting or a healthcare organization with both inpatient and outpatient/clinic settings.
  • Note: Faculty appointments and academic settings are not permitted for this exercise. For all other settings, consult the Instructor for guidance. You do not need actual data from a given organization to complete this Assignment.
• Explain how each rate-based measure (you selected) relates to patient safety, to the cost of poor quality, and to the overall cost of healthcare delivery. Be specific and provide examples.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

**Title:** Exploring Rate-Based Measures of Quality in Healthcare: Implications for Patient Safety, Cost, and Overall Quality

**Introduction:**

In this paper, we will explore three rate-based measures of quality in healthcare and their implications for patient safety, cost of healthcare, and overall quality. Rate-based measures are essential tools for assessing the quality of care provided by healthcare organizations and play a crucial role in informing quality improvement efforts and promoting accountability. By deconstructing each measure, we will gain a comprehensive understanding of its definition, construction, data collection methods, external comparison, risk adjustment, goal setting, and importance to a chosen clinical organization and setting.

**Rate-Based Measures Selected:**

1. Hospital Acquired Infection Rate (HAIR)
2. 30-Day Hospital Readmission Rate (HRR)
3. Patient Satisfaction Rate (PSR)

**Deconstruction of Rate-Based Measures:**

1. **Hospital Acquired Infection Rate (HAIR):**

– **Definition:** HAIR measures the frequency of infections acquired by patients during their hospital stay, excluding infections present at admission.

– **Numerical Description:** HAIR is calculated by dividing the number of hospital-acquired infections by the total number of patient-days or admissions during a specific time period.

– **Data Collection:** Infections are identified through surveillance systems and confirmed based on clinical and laboratory criteria. Data are collected through electronic health records, infection control reports, and laboratory databases.

– **External Comparison:** HAIR is compared externally to other hospitals or healthcare facilities using standardized infection rates (SIRs) or infection-related quality indicators. Percentile rankings may also be used to compare HAIR against national or regional benchmarks.

– **Risk Adjustment:** HAIR may be risk-adjusted based on patient demographics, comorbidities, and severity of illness using statistical methods such as logistic regression.

– **Goal Setting:** In an aggressive organization seeking to excel, goals for HAIR reduction may include achieving SIRs below the national average, implementing evidence-based infection prevention practices, and achieving zero preventable infections.

– **Importance:** HAIR is critical for patient safety as healthcare-associated infections can lead to increased morbidity, mortality, and healthcare costs. Reduction of HAIR contributes to improved patient outcomes, decreased length of stay, and cost savings.

2. **30-Day Hospital Readmission Rate (HRR):**

– **Definition:** HRR measures the percentage of patients readmitted to the hospital within 30 days of discharge for the same or a related condition.

– **Numerical Description:** HRR is calculated by dividing the number of patients readmitted within 30 days by the total number of discharged patients during a specific time period.

– **Data Collection:** Readmissions are identified through hospital administrative databases, claims data, and electronic health records. Data may also be collected through patient surveys or follow-up calls.

– **External Comparison:** HRR is compared externally to other hospitals or healthcare facilities using standardized readmission rates or readmission-related quality indicators. Percentile rankings may be used to benchmark HRR against national or regional averages.

– **Risk Adjustment:** HRR may be risk-adjusted to account for patient demographics, comorbidities, and other factors influencing readmission risk. Risk adjustment models such as the LACE index or HOSPITAL score may be used.

– **Goal Setting:** Aggressive organizations may set goals for reducing HRR by implementing transitional care interventions, improving care coordination, and enhancing post-discharge follow-up. Goals may include achieving readmission rates below national benchmarks and reducing preventable readmissions through targeted interventions.

– **Importance:** HRR is important for patient safety as avoidable readmissions can indicate gaps in care transitions and quality of care. High readmission rates are associated with increased healthcare costs and resource utilization, highlighting the need for effective care coordination and management of chronic conditions.

3. **Patient Satisfaction Rate (PSR):**

– **Definition:** PSR measures the percentage of patients who report being satisfied with their healthcare experience, including aspects such as communication with providers, cleanliness of facilities, and overall care received.

– **Numerical Description:** PSR is calculated by dividing the number of satisfied patients by the total number of patients surveyed or encountered during a specific time period.

– **Data Collection:** Patient satisfaction data are collected through surveys, questionnaires, or interviews administered during or after healthcare encounters. Data may be collected via paper surveys, phone interviews, or online platforms.

– **External Comparison:** PSR is compared externally to other healthcare organizations using standardized patient satisfaction scores or industry benchmarks. Percentile rankings may be used to assess performance relative to peers.

– **Risk Adjustment:** PSR may be adjusted for patient demographics, severity of illness, and other factors influencing patient perceptions of care. However, risk adjustment for patient satisfaction is less common compared to clinical outcomes measures.

– **Goal Setting:** Aggressive organizations may set goals for improving PSR by enhancing patient-centered care, communication skills training for staff, and addressing patient concerns and feedback in a timely manner. Goals may include achieving PSR scores above national benchmarks and implementing strategies to address identified areas for improvement.

– **Importance:** PSR is important for overall quality of healthcare as it reflects patients’ perceptions of care quality, satisfaction, and engagement. High PSR scores are associated with improved patient outcomes, adherence to treatment plans, and loyalty to healthcare providers and organizations.

**Conclusion:**

Rate-based measures of quality play a crucial role in assessing and improving healthcare quality, patient safety, and cost-effectiveness. By deconstructing measures such as HAIR, HRR, and PSR, healthcare organizations can identify areas for improvement, set meaningful goals, and implement targeted interventions to enhance patient outcomes and overall quality of care delivery.

Week 4: Tools and Project Management

By Day 7

Submit your Assignment by Day 7 of Week 4.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK4Assgn2+last name+first initial.(extension)” as the name.
• Click the Week 4 Assignment 2 Rubric to review the Grading Criteria for the Assignment.
• Click the Week 4 Assignment 2 You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer Find the document you saved as “WK4Assgn2+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 4 Assignment 2 Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 4 Assignment 2 draft and review the originality report.

Submit Your Assignment by Day 7 of Week 4

To participate in this Assignment:

Week 4 Assignment 2

What’s Coming Up in Module 3?

In the next module, you will continue your exploration of quality and safety measures in healthcare. You will focus specifically on the quality measures and systems used to support quality improvement initiatives in nursing practice.

Looking Ahead: IHI Modules

• This Assignment requires the completion of 13 IHI Open School modules and the completion of the Certificate of Completion at the Basic level. There are 13 modules that you must complete for these 11 weeks.

• Week 4: Tools and Project Management

To access the IHI Certificate Program, go to IHI.org, and register to create an account. Be sure to enter Walden University as your organization. Under Role, you will select student. Under Organization, you will select school, and under education type, you will select nurse.

Go to the Education tab, and select Open School Courses. Click on Online Courses, and then on Certificates and CEUs. You want to ensure that you are viewing the Basic Certificate in Quality and Safety. Click on Earn Your Certificate Today, and you should be in your student dashboard to begin completing the IHI modules. You will want to click on Go to your Learning Center. On the left-side navigation menu, you will want to Search Catalog to search for, and enroll in, each of the 13 modules required for this certificate.

You will earn contact hours for each module, and once all 13 are completed, you will download the certificate of achievement. Please save this certificate. You will be required to upload this to gradebook in evidence of your completion.

You must complete all IHI modules, and submit your certificate by Day 2 of Week 11.

Week 4: Tools and Project Management

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