Describe the processes (process measures) contributing to the identified problem and identify measurement criteria. Identify any structure measures that are present or needed to achieve outcome measures.

In his book, The Seven Habits of Highly Effective People, Stephen Covey reminds us to “begin with the end in mind”. Dr. Covey is talking about people’s personal quest for improvement. However, wouldn’t the same apply to quality improvement matters? The question is rhetorical and the answer, of course, is “yes”. Before we decide what to do, we must decide where we are going. If you have not determined where you are going, then how do you know when you have arrived, or how close you are to getting to your destination? In quality improvement, we refer to our destination as outcome measures. Most outcome measures are downstream, meaning changes in outcomes are achieved over time and confounded by multiple variables. Process measures are a means to an end. In other words, processes are the activities that affect the outcome measure. For instance, if one wanted to improve patient satisfaction (an outcome measure) the variables affecting patient satisfaction would be examined. One such variable may be the process of communication from the patient to the nurse for patient calls. Perhaps, the first thing the change agent would do is to assess the nurse response time to patient calls (process measure). It may be important to correlate the response time to the hour of the day or the day of the week. The investigator would look for variability (how wide the range) in response times and understand the more variability in the process, the more complex and the more unpredictable the outcome. Standardization of processes decreases the variability of process outcomes and promotes the likeliness of improving downstream outcomes.

Review this online resource for structured measures: https://www.qualitymeasures.ahrq.gov/tutorial/StructureMeasure.aspx

I suspect that you already understood all of this, right? It makes perfect sense. Before we move forward, I want to emphasize a few essential points. First, when facilitating process improvement, it is essential to understand the complexity of a practice concern and the processes influencing outcomes. We often use tools to help us understand the problem, such as a fishbone diagram, a flowchart, a root cause analysis, a failure mode effect analysis or other similar tools. If one doesn’t take the time to understand the issue, improvement strategies, regardless of their evidence-base, do not have a chance of success.

Facilitating process improvement requires a “systems thinker”, one who focuses on the system and processes and not the person. A systems thinker recognizes that to err is human, so he/she attempts to build safeguards into processes to reduce variability of outcomes. Once serving as a legal nurse expert I reviewed a case where a nurse mistakenly gave four times the prescribed dose of digoxin. Subsequently, the patient experienced a cardiac arrest and although revived suffered long term consequences. It is easy to look at a situation and criticize the nurse for the error. Why everyone knows the toxicity of digoxin. How could anyone be so careless? A systems thinker looks differently at the error. The system thinker looks for system breakdowns. For instance, why was this large dosage of digoxin available to the nurse? What was the procedure for pharmacy to check physician orders for drugs before administration? Was there a nurse double check system in place to reduce nurse administration errors? If yes, was it being used? If the double check policy was not being practiced, were there obstacles preventing use of this safeguard? Were alerts available to warn nurses against this dosage of medication? In other words, where were the safeguards to protect against human error? What process failures contributed to the medication error?

Lastly, when selecting the process measures, consider the logistics and difficulty of data collection. Nursing occurs in real time with real people. Human resources are limited. Asking nurses to do one more thing will probably get someone tarred and feathered. Look for measurements already in place so data can be easily obtained.

This assignment begins with your identification of a phenomenon of interest or practice concern in need of improvement. Briefly (one paragraph) describe the proposed quality improvement idea. Demonstrate understanding of the required readings through the development of structure, process, and outcome measures appropriate for your quality improvement project. Share your phenomenon of interest with peers. Review the structure, process, and outcome measurements and appraise their appropriateness in achieving the desired results.

Assignment Instructions:

The focus of this assignment is the appropriate identification of structure, process, and outcome measures . Begin by choosing a Quality Improvement (QI) initiative based on a phenomenon of interest. Remember, the QI topic for this assignment is necessary for context only. If you are a direct care provider, choose a clinical concern; if preparing for an advanced degree in an indirect role (administration or informatics), you may want to select a concern that indirectly affects patient care (nurse satisfaction, retention). Begin with the end in mind and identify the outcome measures. Describe the processes (process measures) contributing to the identified problem and identify measurement criteria. Identify any structure measures that are present or needed to achieve outcome measures. How do you propose to collect measurement data? Take the discussion one step further. Explore what you believe contributes most to the success of quality improvement?

Each student will post an initial post of no more than 500 words in the forum. First person may be used for this assignment.

Each student will then cross post to other students contributing to a robust class discussion. Cross posts should be no longer than 250 words.

APA formatting with reference citations is required

All posts should be posted in the text box. Do not attach a pdf copy of your post.

When posting the initial forum discussion, select “start a new conversation”. Label “Initial Post”.

When posting the cross posts, select “rely to initial message”. Label “Dearmon cross post to Smith”.

No title page is required in the Forum

Turnitin is not required for this discussion.

Label your cross posts following this example: “Dearmon cross post to Smith”.

Critical Elements for a Class Discussion

Follow the directions for the assignment. Keep the focus on the intent of the assignment and do not allow yourself to drift too far. The following critical elements should guide your postings:

Prepare for the assignment by reviewing the unit content and resources. Students should demonstrate graduate level understanding and analysis of the concepts and the relationships among ideas, identifying hidden assumptions or fallacies in reasoning. Students are expected to demonstrate the ability to apply the principles or concepts in the lessons to real-life situations integrating implications for advanced practice. Students should support their opinions with expert opinion through a deep dive into the literature validating thinking and/or broadening perspectives/ understanding of the content.

Cross posts should elaborate upon the ideas of others or content found in the readings/keynotes by adding details, examples, a different viewpoint, or other relevant information. The cross posts should provide original insights or responses which integrates multiple views. (Just saying ditto, I agree, or restating the original post is not considered elaboration.) There should be evaluation and feedback which assesses the accuracy, reasonableness, or quality of idea, and provides constructive feedback to classmates.

The original post and cross posts should provide reflection and meaning by describing thoughtfully what the idea means, uncovering new insights. The cross posts should raise questions as to what needs further clarification or discussion. Personal or professional experiences may be integrated into the cross posts, but are not the sole purpose of the cross posts.

The initial and cross posts should be posted by the due dates allowing time for classmates to respond. The author should monitor their posts and respond to cross posts from other students. The online discussion should mimic a thoughtful classroom discussion. Therefore, the students should demonstrate promptness and initiative in posting and remain engaged throughout the discussion.

The presentation of the post should demonstrate a clear and concise writing style appropriate to graduate level work utilizing appropriate terminology. References should support posts according to APA formatting guidelines.

Grading Rubric for Discussion Questions

Overall points are awarded based on the degree to which the submissions contribute to class discussion. Students must show evidence of engagement throughout the week and postings that reflect application of the assigned lesson materials.

Score

Criteria

5

The posts are timely and relevant. The posts demonstrate thoughtful consideration of the required reading and resources provided in the Lessons section of the course. The initial post fully addresses the required content for the Discussion questions. Ideas are supported by scholarly references. The student actively participated throughout the discussion.

4

The posts are timely, relevant, and self-initiated. The posts reflect understanding of the material presented. The discussion is not fully supported with scholarly references. The initial post addresses the required content for the Discussion questions . The student participated in the discussion in an above average manner.

3

The posts do not add much to the conversation. The posts reflect minimal understanding of the reading and resources provided. Minimal evidential support is supplied for statements. The initial post addressed the majority of the required content in some manner. The student participated in the overall discussion in an average manner.

2

Activity in discussion is minimal and posts lack in substance. The postings fail to demonstrate mastery of the material presented in the readings. The posts fail to meet the expected requirements for the discussion questions.

1

The student failed to participate in the discussion after placing the initial post. The initial post met the assignment requirements.

0

The student failed to participate in the discussion in any manner.

A lack of scholarship point deduction (up to 20% of the total point value of the assignment) will be applied to address deficiencies such as APA errors, a lack of clarity and conciseness in writing, grammatical and spelling errors, exceeding the prescribed work limit, and poor overall writing skills. For this assignment a maximum of 1 point can be deducted. The amount of the deduction will be at the discretion of the faculty grading the assignment.

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