NURS 6231:Week 6: The Quality Movement

Quality is a multifaceted concept that often means differing things to diverse stakeholders. Think about what quality entails for a range of products (e.g., food, television sets, cars) and processes (e.g., the construction of airplanes, how customer service calls are handled for a utilities company).

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In health care, as in other industries, quality can be defined and measured in varying ways. Yet, agencies and organizations have come together in recent years to try to promote shared, achievable goals for quality. This week, you examine the standards proposed by leading agencies concerned with health care quality and safety, and consider how quality is or could be defined and measured in specific organizations.

Learning Objectives

Students will:

  • Analyze methods for measuring quality
  • Apply appropriate measures to a quality improvement initiative*
  • Evaluate approaches for collecting and evaluating data for quality improvement initiatives*

*These Learning Objectives will be assessed in Week 8.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Hickey, J. V., & Brosnan, C. A. (2017). Evaluation of health care quality in for DNPs (2nd ed.). New York, NY: Springer Publishing Company.

  • Chapter 6, “Evaluating of Health Care Information Systems and Patient Care Technology” (pp. 143-170)

This chapter examines federally mandated use of health information technology to improve health care and care delivery.

Sadeghi, S., Barzi, A., Mikhail, O., & Shabot, M. (2013). Integrating quality and strategy in health care organizations. Burlington, MA: Jones & Bartlett Learning.

  • Review Chapter 3, “General Concepts in Quality” (pp. 45–82) (assigned in Week 4)The authors discuss historical perspectives of quality in various industries, and explain the multifaceted nature of defining quality in health care settings.
  • Chapter 4, “Current State of Quality Measurement: External Dynamics” (pp. 83–98)This chapter describes many of the government, nonprofit, and for-profit groups / organizations that contribute to the establishment quality standards and support research to improve the quality of health care.
  • Chapter 5, “Current State of Quality Measurement: Internal Dynamics” (pp. 99–110)This chapter focuses on mandatory and voluntary quality measurement in organizations.
  • Chapter 6, “Measuring Quality of Inpatient Care” (pp. 111–132)This chapter explains the terminology use in quality measurement (e.g., measures, indicators, metrics), and notes that measurement is a critical foundation for the ultimate aim of creating effective changes to improve quality.
  • Chapter 8, “Quantifying the Quality Performance Gaps” (pp. 161–177) 

    This chapter addresses how to quantify current performance and set targets.

Epstein, J. N., Langberg, J. M., Lichtenstein, P. K., Kolb, R. C., & Stark, L. J. (2010). Sustained improvement in pediatricians’ ADHD practice behaviors in the context of a community-based quality improvement initiative. Children’s Health Care, 39(4), 296–311.

Researchers evaluate a quality improvement project on pediatric care of ADHD patients and the sustainability of the improvement over a two-year period.

Gardner, K., Bailie, R., Si, D., O’Donoghue, L., Kennedy, C., Liddle, H., . . . Beaver, C. (2011). Reorienting primary health care for addressing chronic conditions in remote Australia and the South Pacific: Review of evidence and lessons from an innovative quality improvement process. The Australian Journal of Rural Health, 19(3), 111–117.

The authors review data from continuous quality improvement projects, and also discuss key features of continuous quality improvement projects and requirements for supporting an initiative on a larger scale.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.

This report outlines the Institute of Medicine’s (IOM’s) six aims to improve the quality of health care.

Knox, L. M., & Aspy, C. B. (2011). Quality improvement as a tool for translating evidence based interventions into practice: What the youth violence prevention community can learn from healthcare. American Journal of Community Psychology, 48(1-2), 56–64.

This article discusses evidenced-based practice, how it can be used to not only improve healthcare, but also performance in other fields such as youth and family services.

Institute for Healthcare Improvement. (2011). Science of improvement: Establishing measures. Retrieved from http://www.ihi.org/knowledge/Pages/HowtoImprove/ScienceofImprovementEstablishingMeasures.aspx

This piece outlines central tenets of measurement for improvement purposes.

Document: Evidence Matrix (Word document)

Quality is never an accident. It is always the result of intelligent effort.

—John Ruskin

Quality is multidimensional and involves the perspectives of various stakeholders, including patients and families. As noted in this week’s Learning Resources, defining quality is not a simple, straightforward task. Yet, it provides an essential foundation for being able to measure and assess quality, and, ultimately, to improve it.

In this Discussion, you consider definitions and measurements of quality. As you proceed, think about why it is important for organizations to be able to quantify quality and compare current performance to previous performance, to a set of standards, and/or to performance in other organizations.

To prepare:

  • Review the information in the Learning Resources, especially the chapters in the Sadeghi, Brazi, Mikhail, and Shabot course text, focusing on how quality is or could be defined and measured.
  • Think about a health care organization with which you are familiar. It may be the same organization you are focusing on for your Course Project, or a different one. How do you think various stakeholders in this organization would define quality? How would you define quality as it relates to this organization?
  • Review the information on quality standards and / or aims in the Learning Resources, and consider the following:
    • Which outcomes related to quality are currently being monitored in the organization that you have selected?
    • How is related data collected and evaluated?
    • Does the organization use health information technology in this regard? If so, how?
    • How is quality-related information (e.g., data, needs for improvement) communicated throughout the organization?
    • What do you consider to be the strengths and weaknesses of the current approach to quality in this organization?

By Day 3

Post a definition of quality for your selected organization. Describe at least one quality-related measure that is currently being monitored within the organization. Summarize the data collection process for this measure, and explain how this information is communicated to or among the staff. Identify at least one strength and one weakness related to how quality is defined, measured, and/or monitored within the organization.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

  • Compare the organizations’ definitions of quality.
  • Share an insight about how your colleague’s data and information could be used to formulate a quality initiative.
  • Suggest additional options for tracking data.
  • Provide an additional resource to assist a colleague with his or her plan for keeping staff informed and engaged.

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