Healthcare Quality: Analyze Healthcare Quality for Nursing Practice Essay

Healthcare Quality: Analyze Healthcare Quality for Nursing Practice Essay

 

What is healthcare quality?

Stakeholders in healthcare systems have different aspirations and embrace different dimensions to determine how their services increase the likelihood of desired outcomes. Therefore, the average definition of quality care must consolidate multiple dimensions and indicators, including process safety, timeliness, effectiveness, and equity. Also, it is essential to consider whether healthcare services uphold patient-centeredness and evidence-based practice. Consequently, it is possible to define the quality of care as the degree to which healthcare services guarantee positive health outcomes by supporting safety, patient-centered, timeliness, cost-effectiveness, equity, efficiency, and evidence-based practice.

Applying Healthcare Quality Definition to the Work of One Major Quality Pioneer

As stated earlier, quality care must exhibit various dimensions, including safety, equity, efficiency, timeliness, patient-centeredness, and evidence-based practice. In this sense, healthcare stakeholders such as providers and purchasers must align their activities with these indicators. Therefore, this definition consistently borrows insights from Avedis Donabedian’s model. According to Ameh et al. (2019), Donabedian emphasis seven elements of quality medical care, including efficiency, efficacy, acceptability, legitimacy, and equity. Since measuring some of these care quality components is complex, he recommended a triad model of assessment that includes structure, process, and outcomes (SPO) constructs.

Structure Indicators

Under the SPO model, structural indicators are physical and organizational resources that enhance and support healthcare services delivery. Spath (2018) contends that structure measures entail the organization’s capacity or potential for providing quality services. In this sense, it is essential to consider whether the available institutional resources support various dimensions of quality care, including process efficiency, evidence-based practice, timeliness, cost-effectiveness, and patient-centered services. When organizations lack adequate physical and structural resources, they are unlikely to provide quality care.

Process Measurements

Organizational and professional processes are common metrics for determining the quality of care because they impact multiple healthcare indicators and provide information regarding performance at all institutional levels (Spath, 2019, p. 44). In this sense, it is possible to apply process measures in determining how providers interact with other stakeholders to maintain and improve health. According to Agency for Healthcare Research and Quality (AHRQ) (2018), quality care services must address various domains, including process effectiveness, timeliness, efficiency, and patient-centeredness. As a result, measuring organizational processes provide insights into institutional, departmental, and individual mechanisms for promoting quality care.

Outcome Indicators

Apart from structure and process indicators, outcome measures evaluate the results of healthcare services. According to Spath (2018), patients’ health status is a profound outcome measure that provides insights into the effectiveness of structural and process standards. Another outcome measurement is patient satisfaction that offers insights into consumers’ perceptions of care services. In the current healthcare systems, stakeholders must collaborate to consolidate skills, resources, and competencies to reduce mortality, disease prevalence, disabilities and promote positive medical outcomes. Eventually, outcome constructs are consistent with safety, cost-effectiveness, patient satisfaction, and patient-centeredness healthcare quality.

Description of a Healthcare Practice Problem

As a healthcare professional in a psychiatric hospital, I have encountered various challenges in that clinical setting. Despite the prevailing challenges such as medication errors, non-adherence to treatment regimens, staff shortage, and compromised organizational capacity, the prevalence of self-harm behavior and actions pose a challenge in our organization. In this sense, self-harm behavior and actions constitute harmful activities such as self-cutting, ligature tying, self-battery, and self-poisoning (Nawaz et al., 2021). Often, these self-harm activities lead to multiple ramifications, including increased cases of suicide, non-adherence to treatment interventions, including medication and behavioral therapies, injuries, and re-hospitalization. As a result, healthcare professionals in our institution must embrace evidence-based practice and incorporate the best evidence to align structural and procedural aspects with outcome measures to guarantee quality care and eliminate self-harm behavior.

Applying Healthcare Quality Definition to the Selected Practice Problem

Since my definition of quality care encompasses various dimensions, including patient-centeredness, efficiency, timeliness, cost-effectiveness, equity, and evidence-based practice, it is possible to apply it in addressing incidents of self-harm behavior and actions in psychiatric care. Healthcare providers are responsible for identifying risk factors for self-harm behaviors and activities. Although caregivers in psychiatric care settings often ignore the underlying impediments and barriers to quality care, it is essential to conduct root-cause analysis (RCA) to understand causal factors.

Cognitive deficiencies are profound contributors to impaired judgments and self-harm behaviors. However, it is vital to consider additional factors such as loneliness, neglect by care providers, overcrowding, varying coping strategies, and acute stress response when implementing initiatives to address self-harm behaviors among patients in psychiatric care settings. Further, caregivers should develop meaningful interactions with patients to understand their values, perceptions, and behavior to avert incidents of self-harm and suicides due to the sense of loneliness and negligence by healthcare professionals. Finally, the hospital should avail resources and support programs that enhance care and eliminate challenges like non-adherence to medication, inaccessible care, and delayed care. These interventions are consistent with Donabedian’s SPO (structure, process, and outcome) constructs.

Synthesis of Literature

Many scholarly studies propose proven interventions for preventing and intercepting self-harm behaviors in psychiatric hospitals. According to Mapanga et al. (2019), it is possible to strengthen mental healthcare in the primary care setting by encouraging early detection and preventative strategies, alongside implementing psychotherapy and psychosocial interventions. On the other hand, studies by Nawaz et al. (2021), Ulrich et al. (2018), and Quinlivan et al. (2020) recommend additional proven guidelines for enhancing patient safety in psychiatric care settings. Nawaz et al. (2021) propose patient-staff communication, training, and therapeutic interventions to prevent self-harm behavior. On the other hand, Ulrich et al. (2018) require health organizations to transform ward designs to address overcrowding, environmental stress, and aggression. Finally, Quinlivan et al. (2020) recommend organizational policies supporting staff training, patient involvement, and family empowerment to prevent self-harm behaviors and suicides.

Additionally, a study by Timberlake et al. (2020) reveals the effectiveness of cognitive and dialectical behavior therapies, effective models of care that support meaningful relationships between caregivers and patients, mentalization-based group therapy, and patient empowerment in reducing self-harm behaviors in psychiatric care settings. Undoubtedly, these journals provide up-to-date and reliable recommendations for bolstering care quality in psychiatric hospitals. Therefore, it is possible to implement these proposals to address the problem of self-harm behaviors and suicides among patients in a psychiatric hospital.

Conclusion

My definition of quality care consolidates various dimensions, including process efficiency, effectiveness, services’ cost-effectiveness, patient-centeredness, equity, and evidence-based practice. Therefore, these domains are consistent with Donabedian’s model that emphasizes evaluating structures, processes, and outcomes. As a caregiver in a psychiatric hospital, I have identified self-harm behaviors and actions as a quality concern. Therefore, it is possible to apply the definition of quality care in addressing this problem. Some proven interventions to address this challenge are transforming clinical designs to eliminate overcrowding and patient stress, staff-patient education, patient involvement in clinical practices, psychosocial and behavioral therapies, and risk assessment. Many scholarly studies support these strategies; hence they are proven approaches for bolstering care in psychiatric settings.

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References

Agency for Healthcare Research and Quality. (2020). Understanding quality measurement. https://www.ahrq.gov/patient-safety/quality-resources/tools/chtoolbx/understand/index.html

Ameh, S., Gómez-Olivé, F. X., Kahn, K., Tollman, S. M., & Klipstein-Grobusch, K. (2017). Relationships between structure, process, and outcome to assess the quality of integrated chronic disease management in a rural South African setting: Applying a structural equation model. BMC Health Services Research, 17(1). https://doi.org/10.1186/s12913-017-2177-4

Mapanga, W., Casteleijn, D., Ramiah, C., Odendaal, W., Metu, Z., Robertson, L., & Goudge, J. (2019). Strategies to strengthen the provision of mental health care at the Primary Care Setting: An Evidence Map. PLOS ONE, 14(9). https://doi.org/10.1371/journal.pone.0222162

Nawaz, R. F., Reen, G., Bloodworth, N., Maughan, D., & Vincent, C. (2021). Interventions to reduce self-harm on in-patient wards: Systematic review. BJPsych Open, 7(3). https://doi.org/10.1192/bjo.2021.41

Quinlivan, L., Littlewood, D. L., Webb, R. T., & Kapur, N. (2020). Patient Safety and Suicide Prevention in Mental Health Services: Time for a new paradigm? Journal of Mental Health, 29(1), 1–5. https://doi.org/10.1080/09638237.2020.1714013

Spath, P. (2018). Introduction to healthcare quality management (3rd ed.). Healthcare Administration Press.

Timberlake, L. M., Beeber, L. S., & Hubbard, G. (2019). Nonsuicidal self-injury: Management on the Inpatient Psychiatric Unit. Journal of the American Psychiatric Nurses Association, 26(1), 10–26. https://doi.org/10.1177/1078390319878878

Ulrich, R. S., Bogren, L., Gardiner, S. K., & Lundin, S. (2018). Psychiatric ward design can reduce aggressive behavior. Journal of Environmental Psychology, 57, 53–66. https://doi.org/10.1016/j.jenvp.2018.05.002

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LC4002A: Healthcare Quality
LC4002A Assessment Instructions
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Review the details of your assessment including the rubric. You will have the ability to submit the assessment once you submit your required self-assessments and engage with your Faculty Subject Matter Expert (SME) in a substantive way about the competency.

Overview
In this Performance Task Assessment, you will consider healthcare quality issues that you observe in practice. You will also locate evidence that relates to the issue from scholarly sources.

Looking Ahead
Over the course of Competencies LC4002A – LC4005A, you will be going through the steps of your Quality Improvement Project which will be submitted in LC4005A. During each Competency, you will complete one or more parts of the final project, and in LC4005A, you will use these parts to create the final project.

This practice experience project has six parts:

Analyze available evidence and identify a quality improvement practice problem;
Conduct a literature search finding data and evidence-based solutions/interventions to support the importance of the quality improvement practice problem;
Identify the quality improvement tools (Fishbone diagram, Pareto Chart, Process Flow Chart, etc.) that will display the data supporting the need for the Quality Improvement Project;
Apply the PDSA process to the development of the Quality Improvement Project;
Develop an evidence-based plan to address the quality improvement practice problem; and
Present the final Quality Improvement Project as a comprehensive paper and quality improvement storyboard.
The practice experience is an active learning process that provides you with the opportunity to apply your nursing knowledge by addressing a quality improvement practice problem. The practice experience is comprised of selected onsite experiences and completion of a Quality Improvement Project with guidance from your subject matter expert. For additional information on the practice experience, follow this link: https://academicguides.waldenu.edu/fieldexperience/son/home

The practice experience guide can also be found here: https://academicguides.waldenu.edu/ld.php?content_id=45642029

Instructions
To complete this Assessment, do the following:

Be sure to adhere to the indicated assignment length.
Download the Academic Writing Expectations Checklist to review prior to submitting your Assessment.
Before submitting your Assessment, carefully review the rubric. This is the same rubric the SME will use to evaluate your submission and it provides detailed criteria describing how to achieve or master the Competency. Many students find that understanding the requirements of the Assessment and the rubric criteria help them direct their focus and use their time most productively.

All submissions must follow the conventions of scholarly writing. Properly formatted APA citations and references must be provided where appropriate. Submissions that do not meet these expectations will be returned without scoring.

This Assessment requires submission of one (1) document, a 3–4-page paper. Save this file as: LC4002A_firstinitial_lastname (for example, LC4002A_J_Smith)

You may submit a draft of your assignment to the Turnitin Draft Check area to check for authenticity. When you are ready to upload your completed Assessment, use the Assessment tab on the top navigation menu.

Important Note: As a student taking this Competency, you agree that you may be required to submit your Assessment for textual similarity review to Turnitin.com for the detection of plagiarism. All submitted Assessment materials will be included as source documents in the Turnitin.com reference database solely for the purpose of detecting plagiarism of such materials. Use of the Turnitin.com service is subject to the Usage Policy posted on the Turnitin.com site.

Addressing Quality Issues in Healthcare
As a practicing nurse, you probably see falls, CLABSI, CAUTI, MRSA infections, and other such issues arise from time to time. No facility is immune to safety issues, and, as a nurse leader, it is your job to identify these issues and work to address them using evidence.

In this Performance Task Assessment, you will discuss healthcare quality and the pioneers that shaped current practices. You will also consider a practice problem that might be present in your practicum facility and locate evidence surrounding the problem.

In a 3- to 4-page paper, address the following:

Define healthcare quality in your own words and apply it to the work of one major quality pioneer as listed in the Spath (2018) textbook (Shewhart, Deming, Juran, Ishikawa, Crosby, Feigenbaum, etc.).
Describe a healthcare practice problem that you have had some experience with as a consumer or as a practitioner in healthcare. The practice problem you identify must be supported by data that is available to you in your practice setting and justifies that a problem exists. This problem will be the basis for your quality improvement practicum project you will complete in the upcoming competencies (LC4003, LC4004 and LC4005). Explain how your definition of healthcare quality might apply to your selected practice problem and your experiences with it.
Locate 5 sources of scholarly evidence published within the last five years that describe potential solutions or interventions that you can implement as part of your practicum quality improvement plan. A scholarly piece of evidence could be a journal, government agency, white paper, or professional organization. Synthesize the information in the 5 articles. Note that a synthesis of information is not a summary of each source. A synthesis involves critical reading to make connections between sources, compare the similarities and differences, highlight important information, and present new ideas based on your interpretation of the information.
Note: You will use this practice problem in your practicum project that you will work on throughout this area of expertise. Your faculty SME will provide approval for your practicum project topic in the feedback for this Assessment. Be sure to review it and address any comments in subsequent assessments.