Week 5: Roles of Health Professionals

1) I expected to learn about the different roles of health care professionals.

2) I actually learned about working together as an interdisciplinary team to provide quality care. Chapter 4 in our text discusses different approaches to improve outcomes produced by teams by examining how the team functions together or the issues preventing its functioning (Sollecito & Johnson, 2013). First, quality problems are not always visible to senior management leaders, but can be seen frequently by staff nurses or others and the problems end up impacting everyone at all levels. Persons at the lowest level of health care often acquire considerable expertise and have great ideas for fixing problems—so they are a valuable member of a team and need to be listened to. For example, receptionists in an Emergency Department can more easily see why wait times are increased, versus the manager in his office. Sollecito and Johnson (2013) stated that “a substantial proportion of health care quality problems reside in communication structure problems in the organization” (p. 148). By focusing efforts on cohesiveness in communication, problems can be solved quicker and more efficiently. Using a centralized structure where information passes from the team leader down to team members is effective. In a very complex environment, using an all-channel open communication approach is better. This way teams can network and communicate with other units/teams (p. 149). Team characteristics such as size, relationships, status, psychological safety (team members perceive it is okay to take risks among the team for process improvement), and team norms all impact how a team functions.

            Teams are people who work together towards specific goals. They use multiple interconnected processes and produce performance outcomes. Chapter 4 also states that teams need to be able to adapt to changing circumstances and continue with quality improvement. Health care is a dynamic environment and needs the building blocks of teams to ensure its proper function. 

3) I enjoyed the discussion activity about the 11-year old patient with Juvenile Diabetes that continued to be readmitted to the hospital for non-compliance. After assessing the patient’s situation in more detail, our team was able to come to a consensus that the grandmother needed greater education on diabetes, blood sugar control, cooking meals that conform to a consistent carbohydrate diet, and ensuring the patient had proper insulin administration in relation to his blood sugars. Ensuring this is all properly communicated to her via a translator was the most appropriate plan of action. The interdisciplinary team would work most effectively together if the patient, parents, and grandparents were all educated together, and then if the school nurse was also aware of the patients’ diabetic care plan. This way, at home, at school, and then with his check-ups, all care team members would be aware of his diagnosis, dietary plan, and insulin needs.  

This experience taught me to make sure I am looking at all possibilities for situations and then finding solutions for them. I also realized the importance of an interdisciplinary care team. If everyone is properly communicating to one another, greater outcomes will be established for the patient and no gaps of knowledge will exist.

4) I plan to utilize this information in my nursing practice by working as a team and ensure I properly communicate information regarding patients to those involved in their care (i.e. nurse to nurse report, shift report to charge nurse, at patient discharge to a facility, if other team members such as physical therapy come to work with the patient I will inform them of their situation for patient safety).

5) I have always loved healthcare because greater things are accomplished for patients when working together as a team. There are definite team dynamics where some persons seem easier to work with. Others you may feel like you automatically understand their unspoken intentions and will just start to work side-by-side to best help the patient. Overall, communication amongst all disciplines will help everyone be on the same page. Each professional does have their specific role, but when working together, care is optimized for the patient. 

Reference

Sollecito, W. A., & Johnson, J. K. (2013). Mclaughlin and Kaluzny's continuous quality improvement in health care. Burlington, MA: Jones & Bartlett Learning.

Week 4- Legal and Ethical Issues in Quality Improvement

            Before beginning this unit, I expected to learn about legal and ethical issues affecting quality improvement in healthcare. I actually learned a great deal about legal and ethical issues. Our group discussed a case study about a young girl, named Elsa, who was diagnosed with fibromyalgia shortly after obtaining her dream job as an elementary education teacher. We concluded her life would be negatively impacted with this new diagnosis, leading to depression and suicidal ideation. Sadly, suicide would be a viable option for Elsa. Although, as her nurse, we would focus all our efforts on preventing Elsa from doing this by helping her find value in her life and coping with this disease. I researched different support services that would be available to Elsa. I was surprised to find social media support groups, in-home physical therapy assistance, and countless online resources educating a person all about fibromyalgia and how to live with it. There are many ways to live a fulfilling and successful life, even with the disease. Pain management and emotional/mental support via counseling are two areas of focus for the nurse to keep Elsa’s spirits uplifted.

            The discussion asked if assisted-suicide was a viable option for Elsa. I did some research and found that it was not. Only certain states in the U.S. allow assisted-suicide, including Oregon, Washington, and Vermont (Oregon Public Health Division, 2015). Certain criterion must be met in order to be considered, including age over 18 years, being of a sound mind, and being diagnosed with a terminal illness with six months left to live. This, of course, is determined by the physician. A lethal dose of medication would then be prescribed to be ingested by the patient at home.

            I also researched an article on legal and ethical issues in quality improvement. The article discussed legal issues from the implementation of Electronic Health Records (EHRs) in countries around the world and in Emergency Departments specifically (Ben-Assuli, 2015). EHR systems require more time being dedicated to charting and less to the patient experience. Initially when learning the system, clinicians often will make personal mistakes in how they enter information leading to adverse medical events and errors. When charting in EHRs clinicians may copy and paste data obtained from other clinicians, give inadequate discharge summaries, accidentally send information to unintended places, easily get authorship misnomers, and the efficiency of EHRs can lead to carelessness in charting and harmful shortcuts (i.e. lacking patient specific information and giving over-generalized information to save time via pasting information). This results in poorer care for the patient, since all of their needs/issues may not be getting addressed with these charting shortcuts. This is something, I personally, have witnessed in the Emergency Department. Charting electronically seemed redundant at times and became less patient-specific due to time constraints and the ease of copying and pasting information. Even though EHRs have contributed to easy sharing of patient information and storage, it is still important to remember care is always patient-centered and requires clinicians to pay special attention to details to prevent errors and continue improving the quality of care delivered, whether electronically or in person.

            I also learned about an 85 year old female patient with walking pneumonia who got up to use the restroom and then “eased herself to the ground” due to feeling light-headed. The World Health Organization (WHO) defines a fall as “an event which results in a person coming to rest inadvertently on the ground or floor or other lower level” (2015). According to this criteria, this patient experienced a fall. Many different factors contribute to falls including, but not limited to, age, patient impulsivity/confusion/disorientation, certain medical diagnoses, vital signs outside of normal parameters, morbidly obese or frail patients, and moderate to maximum assist patients. It is essential that nurses document event forms when falls occur so process improvement measures can be implemented to lead to better outcomes. Some of these measures can include ensuring beds are in the lowest position, at least two side rails are up, a bed alarm is on and hooked to the patient, the patient is educated to ask for help, the call light is within reach and signs are on the door.

            My personal feelings about the material covered are that with all process improvement endeavors, there will be legal and ethical issues associated with them. These issues can be addressed by understanding the complex nature of processes and implementing quality improvement models such as Plan-Do-Check-Act, by W. Edward Deming, to fix and evaluate processes to improve them even more. Healthcare will always consist of continuous quality improvement.             

References

Ben-Assuli, O. (2015). Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments. Health Policy, 119(3), 289- 297. doi: 10.1016/j.healthpol.2014.11.014

Oregon Public Health Division (2015). FAQs about the Death with Dignity Act. Retrieved from https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/Deathwit            hDignityAct/Pages/faqs.aspx

World Health Organization (2015). Falls, fact sheet. Retrieved from             http://www.who.int/mediacentre/factsheets/fs344/en/

Quality Improvement Strategies I- Overview

            The Funnel Experiment, developed by W. Edwards Deming, demonstrates interesting aspects of quality care in healthcare settings (Mayo Clinic, 2012). A basic overview of the experiment consists of dropping a marble down a funnel in hopes of it landing on a marked “x.” Even when one drops the marble multiple different times, it may or may not hit the target. Sometimes this can be frustrating and so the person dropping the marble will try to change things in the system by moving the funnel’s position, changing the size of the marble, dropping the marble differently, and even changing the temperature of the environment. As time goes by with the marble dropping, even greater variation ends up taking place than what would have originally taken place had they stuck with the original method. In this example, Deming is trying to show that when well-meaning persons tamper with any type of system or process, outcomes only became worse over time and complexity greatly increases.  

            In quality improvement, it is best not to react to variations in a stable system. No matter what, all processes will vary and this needs to be remembered. Focusing on outcomes will generate better results than focusing on the processes leading to outcomes. The Funnel Experiment is a great analogy for healthcare quality improvement showing that strong leadership who remain focused on outcomes will generate better results and decreased costs.

            From the PowerPoint on chapter two (Sollecito & Johnson, 2013), I learned about the Checklist Continuous Quality Improvement methodology. It originated in aviation and has spread to healthcare. Implementing checklists has significantly decreased central-line infections and allowed for better outcomes in the surgical centers. To be most effective, the checklists depend upon effective leadership, interdisciplinary teamwork, use of a Plan-Do-Study-Act cycle, and engagement of experts on a global scale to improve safety.

            Research shows check-lists (and other QI processes) have been effective in improving care overall, but the question remains as to why healthcare continues to have errors and adverse events occur. Why has not much improvement occurred especially when so many QI processes are in place and available? Two key issues have been shown to not only impede the implementation and adherence of check-lists, but virtually all QI processes in healthcare. These are complexity and cost.  Experts have tried to simplify the matter showing that incentives for improvements, maximizing value and minimizing costs, with effective leadership is what will be most effective in improving quality in healthcare. Because healthcare is so complex, it requires diligence to spread the improvement process (Sollecito & Johnson, 2013).  
           I plan to be a strong leader by adhering to quality improvement processes and standards in my nursing practice. I plan to focus on outcomes and not tamper with systems even if I am well-meaning. My goal is to rally others together in the workplace to work as a team in improving processes. My efforts and their efforts can start improving healthcare at a small scale, but hopefully this diligence can spread.  

Reference

Mayo Clinic. (2012 May). The funnel experiment. Retrieved online from Youtube https://www.youtube.com/watch?v=2VogtYRc9dA&list=PLMB9evqeBMEjBxqB8dNS9CFhcsI0uHJIh&index=7

Sollecito, W. A., & Johnson, J. K. (2013). Mclaughlin and Kaluzny's continuous quality improvement in health care. Burlington, MA: Jones & Bartlett Learning

Reflective Journal- Week 2

            The United States has the most costly healthcare system but major quality and safety issues persist (Davis, 2010). An article from Agency for Healthcare Research and Quality (AHRQ) compares the years 2002 and 2012 to determine the most costly health conditions in the U.S. In both years, the same five medical conditions (heart disease, trauma related disorders, cancer, chronic obstructive pulmonary disease and asthma, and mental disorders) were ranked highest for medical spending (Soni, 2015). The data presented in this article shows that expenditures have risen in some areas (mental health) and have stayed nearly the same in other areas (heart disease and cancer)—proving that the same costly medical conditions have continued to exist over the past decade. These problems aren’t being fixed, proving the need for quality improvement in our healthcare system.

             Quality is constituted by the degree of excellence something possesses, as compared to other things of a similar kind (Google Chrome online definition). In class, we also learned quality to be defined as the science of process management. Florence Nightingale was a prime example of contributing to quality improvement with her genuine caring, data collection, and use of statistics for data visualization. Her research helped show others in her day about the need for improved care through better sanitation measures for patients. Now different national organizations have been implemented to support nurses in giving quality care with research, data collection, and evidenced-based practice. The Institute of Medicine, Robert Wood Johnson Foundation, American Nurses Association, and National League for Nurses are a few of these organizations helping set standards of quality care. They conduct research on our behalf to find ways to prevent errors, improve outcomes, and improve processes. One of their most important goals is to encourage nurses to attain higher levels of education in nursing so they can render safe care and be able to implement change as leaders themselves. (I am currently in the Bachelors of Nursing program because of this.)

            During this unit we also learned about Deming’s 14 Points of Profound Knowledge for quality improvement. His system stated that usually quality improvement ideas sound great, but in reality, they forget the complexity of life. So many x-variables affect the y-dependent outcomes and a thorough examination of systems, variation, theories, and human behavior is only what will lead one to find the profound lens of knowledge (QI idea) suitable for solving the problem or enacting positive change (Lloyd, 2009). The quality improvement team must take into account the different common causes and special causes while looking for different trends, in order to help identify more thorough quality improvements.  It begins with working as an interdisciplinary team, establishing leadership, removing slogans and fear, and maintaining a continuous quality improvement philosophy.

            In our Quality Improvement Lecture, we also learned that quality care is meeting customer expectations. In healthcare, the patient is the customer. I want my patients to feel safe and confident that they are receiving the best possible care. If every practicing nurse can adapt the philosophy of continuous quality improvement and abide by it, I believe medication errors, hospital acquired infections, falls, central-line infections, bed sores, (etc!) can be decreased substantially. This would be the epitome of quality healthcare.

References

Davis, K., Schoen, C., & Stremikis, K. (2010). Mirror, mirror on the wall: How the performance of the U.S. health care system compares internationally, 2010 update. Retrieved from http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2010/Jun/1400_Davis_Mirror_Mirror_on_the_wall_2010.pdf

Lloyd, R. (2009 January). Deming’s System of Profound Knowledge 2. Retrieved from the IHI’s

online course https://www.youtube.com/watch?v=STTwZGNvLmM&list=PLMB9evqeBMEjBxqB8dNS9CFhcsI0uHJIh&index=4

Soni, A. (2015 April). Statistical brief #470: Trends in the five most costly conditions among the U.S. civilian noninstitutionalized population, 2002 and 2012. Agency for Healthcare Research and Quality. Retrieved from http://meps.ahrq.gov/mepswe/data_files/publications/st470/stat470.shtml

Critical Thinking #2- Week 2

1. What I consider elements of quality care when receiving healthcare services are:

-they make eye-contact with me and smile

-the professional considers and values me as a person with feelings

-adherence to standard hand hygiene

-explains why they do what they are doing

-medications are labeled always

-the professional teaches me more than what I already know; they can always answer my questions, and if not, they will research an answer for me.

-they show empathy and compassion

-when they go the extra mile to fix problems

-they update the white-boards to keep me informed

-they keep me updated and check on me frequently

-they are prompt and come when they say they will

2. As a professional nurse, I believe the elements of quality care are what I have just stated above. I would also like to add improved patient outcomes and being knowledgeable about diverse cultures so care is tailored more specifically to the patient (i.e. patient-centered care). I have always believed in the “Golden Rule” and to treat my patients how I want to be treated. Adhering to hospital policy and standards of nursing care are the key elements of quality care, while showing empathy, respect and compassion to meet the patient’s emotional needs.

3. Whether on the receiving or giving ends of patient care, the quality of care should be no different. I will always treat patients my very best, and in return, I hope I am treated the best as well.