The purpose of this assignment is to discuss the purpose and use of the continuous quality improvement (CQI) process.
In a 1,000-1,250 word paper, address the following:
Explain the need for CQI in health care.
Describe methods of CQI used in health care.
Describe factors that have an effect on the CQI process.
Describe the overall impact that the CQI process has on staff.
Describe the overall impact that CQI initiatives have on patient outcomes.
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The Concept of Continuous Quality Improvement in Healthcare
Quality healthcare has become a central tenet of all healthcare services. It is no longer sufficient to realize large volumes but necessary to add value. In the United States, this has been demonstrated by the Patient Protection and Affordable Care Act or ACA 2010 (Obamacare). This revolutionary federal healthcare policy came up with a provision for honoring only those reimbursements that are claimed against quality healthcare services given by providers. It is called the pay-for-performance clause (Holmström, 2017). It has since changed the focus of healthcare services in the US from volume-based to value-based healthcare (Kominski et al., 2017). Because of these provisions that demand continuous delivery of quality healthcare services, healthcare organizations find themselves needing continuous quality improvement (QI). To ensure that this is actually done, there are various regulatory bodies that inspect healthcare organization records for signs of lapses in quality control. Theirs is a supervisory and regulatory role and they include the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Agency for Healthcare Research and Quality or AHRQ. But continuous quality improvement is also driven by something even more substantive. That is the doctrine of evidence-based practice or EBP. This states that healthcare professionals such as nurses must always exclusively use only those interventions whose efficacy is supported by current peer-reviewed scholarly and published literature (Melnyk & Fineout-Overholt, 2019). But the body of EBP knowledge is dynamic and continuously changes. For this reason, clinical practice must also keep up pace and change accordingly. This is why healthcare organizations need to have continuing quality improvement programs and initiatives. The purpose of this paper is to analyze what QI is and what QI models are in the context of the healthcare organization.
The Need for Continuous Quality Improvement (CQI) in Healthcare
It has already been stated in the introduction above that the application of EBP in clinical practice is one of the most important factors that necessitate continuous quality improvement (CQI) in healthcare. But even with that, the main reason behind EBP and the need for CQI is the realization of the best patient outcomes after applying interventions. These good patient outcomes do not just come about by themselves. For outcomes to be favorable and acceptable, the care given must be safe, efficient, effective, timely, patient-centered, and equitable (Tzelepis et al., 2015). This is the description of quality healthcare. Healthcare organizations use various measurable quality indicators to determine whether they are delivering quality services. It is also these same measurable quality indicators that are used by the regulatory organizations such as AHRQ and JCAHO to assess for quality compliance and award accreditation. The indicators include the readmission rate, ventilator-acquired pneumonia (VAP) rate, central line-associated bloodstream infection (CLABSI) rate, catheter-associated urinary tract infection (CAUTI) rate, accidental patient falls rate, and pressure ulcer rate amongst others. Training staff on continuous QI using evidence-based strategies is therefore clearly paramount for healthcare organizations (Field et al., 2014). The Concept of Continuous Quality Improvement in Healthcare Essay Paper
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Methods of CQI Utilized in Healthcare
Actualization of continuous QI in healthcare organizations requires the utilization of scientific and systematic processes represented by QI models. Each of these models takes a different approach to quality improvement but the goal remains the same. Examples of these models are FADE, LEAN, Total Quality Management (TQM), and Six Sigma amongst others (Spath, 2018). In healthcare, however; one of the most used CQI models is FADE. It stands for Focus, Analyze, Develop, and Evaluate (Spath, 2018). After a problem with quality is suspected, the QI team first determines the exact nature of the problem and comes up with the problem statement (Focus). Then they analyze the problem and decide the resources needed as well as the possible evidence-based solutions (Analyze). After that comes the ‘Development’ of solutions and their implementation. Lastly of course is evaluation of the effectiveness or otherwise of the evidence-based solutions implemented (Spath, 2018). These steps are for the FADE model but as stated above, the other models are also unique in their own way with their own set of steps. The goal remains the same though – CQI. The Concept of Continuous Quality Improvement in Healthcare Essay Paper
Factors Having an Effect on the CQI Process
Some of the factors that have an effect on the CQI process are the knowledge of the staff about research and EBP, the availability of resources, organizational culture with regard to readiness for change, and the leadership style of the nurse leaders in the organization. In an organization with majority baccalaureate nurses, it would be expected that the nursing workforce would be knowledgeable about research and EBP. This will not be the case for an organization with majority ADN or associate-degree nurses. ADN nurses unlike baccalaureate nurses are trained more on the practical aspects of nursing practice and lack the knowledge required for understanding research, clinical inquiry, and PICOT which are the leading tenets of EBP. Being a project, it would be expected that resources are availed for the CQI project. Staff resistance to change as an organizational culture would also affect the CQI process in profound ways. The employees must therefore give their buy-in for the process to succeed. Lastly but not least, the nurse leaders leading the CQI change processes must be transformational leaders to motivate, inspire, and empower their nurses to deliver the change and improve patient outcomes (Choi et al., 2016).
CQI is a change process. For this reason, the leaders must choose a change model to guide the process every time. This could be the transtheoretical model of change (TTM) or Roger’s Diffusion of Innovations model. Each of these models has specific steps that initially require that the proponents of the CQI change convince and obtain buy-in from the staff. This is not an easy task. However, it will be made easier if the nurse leaders driving the process are transformational leaders who have made a good relationship with their employees. They will have created a welcoming working environment that makes the nurses feel wanted, valued, and part of the organization. With this kind f empowerment and motivation, the nurses will willingly and readily give their buy-in and see to it that the CQI process is completed successfully.
Impact of the CQI on Staff and Patient Outcomes
The impact of the CQI process on staff is a disruption of the status quo. As stated above, CQI processes are change processes that remove the staff from their comfort positions. They have to learn a new way of doing things to maintain quality and therefore there is an element of stress. This is what explains the resistance of some staff to change within the organization. On the other hand, the impact on patient outcomes is positive always. This is because the ultimate goal of QI initiatives is to improve patient outcomes.
CQI processes within the organization are inevitable. They are change processes that must occur if the organization is to comply with the quality expectations of regulatory bodies like the JCAHO. More importantly, the change processes must always occur if the organization is to entrench evidence-based practice or EBP.
Choi, S.L., Goh, C.F., Adam, M.B.H., & Tan, O.K. (2016). Transformational leadership, empowerment, and job satisfaction: The mediating role of employee empowerment. Human Resources for Health, 14(1), 73. https://doi.org/10.1186/s12960-016-0171-2
Field, J.M., Heineke, J., Langabeer, J.R. & DelliFraine, J.L. (2014). Building the case for quality improvement in the health care industry: A focus on goals and training. Quality Management in Healthcare, 23(3), 138-154. https://doi.org/10.1097/QMH.0000000000000036
Holmström, B. (2017). Pay for performance and beyond. American Economic Review, 107(7), 1753–1777. https://doi.org/10.1257/aer.107.7.1753
Kominski, G.F., Nonzee, N.J. & Sorensen, A. (2017). The Affordable Care Act’s impacts on access to insurance and health care for low-income populations. Annual Review of Public Health, 38. https://doi.org/10.1146/annurev-publhealth-031816-044555
Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4th ed. Wolters Kluwer.
Spath, P.L. (2018). Introduction to healthcare quality management, 3rd ed. Health Administration Press.
Tzelepis, F., Sanson-Fisher, R., Zucca, A., & Fradgley, E. (2015). Measuring the quality of patient-centered care: Why patient-reported measures are critical to reliable assessment. Patient Preference and Adherence, 9, 831-835. https://doi.org/10.2147/ppa.s81975 . The Concept of Continuous Quality Improvement in Healthcare Essay Paper