Model for Improvement, Quality and Change Management - Essay Example

Model for Improvement Name Institution Name Date Introduction Healthcare systems supposed to be effective, efficient, quality to the community, users and founders. Different health units employ different approaches to improving the standards and quality of the healthcare services. Quality assurance in international organization and countries employs professionals to oversee the entire process. They use participatory techniques in quality assurance to further the requirements of the community. Healthcare systems and sectors have employed different approaches to ensuring the quality of the services and products are improved. Numerous models exist, which are applicable to different operational requirements. In a hospital setting, there are different departments that require different operational requirements. Improvement models are based on operational and situation requirements. An example of the framework is the Model for Improvement. The aim of this paper is to discuss the Model for Improvement based on the PSDA cycle perspective. The paper introduces the Model for Improvement, discusses the important components of Model for Improvement, and uses the Model for Improvement a surgery department quality and change requirements. Model for Improvement: Rationale for Choice of Quality Improvement Model for Improvement traces its roots to the Plan-Do-Study-Act Cycle and Theory of Profound Knowledge (Randolph et al., 2009). The important components of Model of Improvement include quick to apply; it works, success by numerous users based on different environments and applies both to the process and products with a range of application from simple to complex. The Model for Improvement can be used in any environment but dependent on the will to change, ideas for change and execution of the idea (Langley et al., 2009; Kyrkjebø & Hage, 2005). The Model for Improvement has three uses that are to test ideas, implement ideas and develop new knowledge (Muntlin, Carlsson & Gunningberg, 2010). Conversely, the Model for Improvement is not applicable to insufficient will to improve, and an alternative improvement has already been employed (Heck & Hallinger, 2010). Model for Improvement was chosen because it applies to the various levels within an organization (Hoyt & Gopal‐Agge, 2007). The support staff, providers, and executives, can use the model and also it applies to low volume processes, high volume process to informal and well-defined processes (Tomolo, Lawrence & Aron, 2009). The model is also maximally adaptive and also is minimally prescriptive (Randolph et al., 2009). In addition, its formality status varies depending on what should be improved (Janes & Mullan, 2007; Kyrkjebø & Hage, 2005). The model does not require experts since it can be used easily and usually stresses ion learning, user empowerment and growth of knowledge (Berry et al., 2009; Jeske et al., 2006). Therefore, the model is easy to use, and it can be introduced to any setting provided there are clearly defined background information that guides the entire process. It is important to have the content and determine the determinants of the context to enable developing the appropriate content to sustain the change (Langley et al., 2009; Kyrkjebø & Hage, 2005). Components of Model for Improvement – PDSA Cycle The Model for Improvement has tools that can be used and the components of the PDSA documentation (Langley et al., 2009; Kyrkjebø & Hage, 2005). The tools include aim statement that has targets or goals, description of key measures and through the rational form; concepts and ideas can be changed. The PDSA Cycle for learning and improvement incorporates a plan, do, study and act (Berry et al., 2009). These components complement each other because all operates seamlessly through complementation and support (Gillam & Siriwardena, 2013; Kyrkjebø & Hage, 2005). For example, the Model of Improvement and PDSA complements each other in which the strengths of the PDSA components are used to support the three important expectations of the Model for Improvement (Janes & Mullan, 2007; Jeske et al., 2006). Critical Analysis of the Components of the model for Framework In general, the model can be viewed in two stages, which one is the tools while the second is PSDA cycle (Oyler et al., 2008). The first stage addresses three fundamental questions that are important for the improvement of the work (Peden & Rooney, 2009; Siassakos et al., 2010). The first fundamental question is “what are we trying to accomplish” (Randolph et al., 2009). The first question tries to define the objectives of the projects and the expected goals (Tomolo, Lawrence & Aron, 2009). It highlights outcomes of the entire process; for instance, to reduce number of infections during surgery by 20% after six months of 400 patients. In setting the aims, the requirements define the aims of improvement required. The object as presented in the example should be measurable and time specific (Berry et al., 2009). It also requires defining the population of patients that will be affected or analyzed (Hwang, Wen & Chen, 2010; Siassakos et al., 2010). The second fundamental question is based on “how will we know whether a change is an improvement?” This brings into consideration the measurements that gauge the outcome of the process (Langley et al., 2009). For the earlier example, the measurement is reduction of new infections by a rate of 20% within six months meaning that the success of the program is to meet these numbers (Janes & Mullan, 2007; Kyrkjebø & Hage, 2005). The quantitative measures are the most important since it gauges based on expectations leading to an improvement (Tomolo, Lawrence & Aron, 2009). For example, if the statistics indicated through the highlighted example suffices, and the analysis is based on qualitative analysis, it means the expected improvement has been achieved (Randolph et al., 2009). The final question component is “what changes can we make that will result in improvement?” Numerous types of changes exist but it requires identification of a specific change. It is attributed to the fact that all changes do not count to improvement (Tomolo, Lawrence & Aron, 2009; Jeske et al., 2006). It means organizations are supposed to introduce changes that result in quantifiable improvement (Muntlin, Carlsson & Gunningberg, 2010). It can be achieved by checking the current operations and predicting whether changing some features will result in improvement (Langley et al., 2009; Kyrkjebø & Hage, 2005). The plan discusses the objective of the project, predictions and questions that are based on why and how the cycle can be actualized (Janes & Mullan, 2007; Dunsford, 2009). Some of the information asked include who, what, where and when. In addition, the planning stage discusses on how the data can be collected (Langley et al., 2009). The stage also provides mechanisms and avenues in which data is collected for the entire cycle. It is important to collect useful data, and qualitative data is preferable to quantitative data (Tomolo, Lawrence & Aron, 2009; Nakajima, Kurata & Takeda, 2005). The stage also allows record wrongs that happen during collection of the data and effective sampling techniques reduce burdens associated with a collection of data (Gillam & Siriwardena, 2013; Jeske et al., 2006). The do section is the actual approach of carrying out the plan (Langley et al., 2009). The stage also allows documentation of both unexpected observations and any other problems. It also allows data analysis to understand the data (Langley et al., 2009; Litaker et al., 2006). This stage is crucial because it highlight challenges that may occur and forms the basis of the entire (Tomolo, Lawrence & Aron, 2009). It requires effective documentation to enable determining how things have been accomplished and the success rate of these numerous activities (Janes & Mullan, 2007). The data is grouped based on the aims and objectives with the aim of understanding and elaborating on the data (Tomolo, Lawrence & Aron, 2009). The study state provides a platform of completion of data analysis (Janes & Mullan, 2007; Siassakos et al., 2010). The data that is obtained is used to compare with the predictions. The section also summaries what was learned. The prediction (data) enhances the learning process, improves and adds fun to the improvement work, and employs the use of test cycle measures (Randolph et al., 2009). Predicting an outcome also shows the persons using the technique have clearly defined expectations and have the guidelines on arriving at the expectation (Tomolo, Lawrence & Aron, 2009). Predicting the results ensures the persons performing the quality assurance understand the dynamics of the entire process (Hoyt & Gopal‐Agge, 2007). The final stage is to act. The stage defines the changes that should be made and introduces the next cycle (Langley et al., 2009; Litaker et al., 2006). Acting is based on the information and data collected from the numerous stages. It defines what is viable and what measures should be employed to actualize the entire process (Shams & Golshiri, 2005; Siassakos et al., 2010). Acting ensures what has been learned is integrated into the different systems within the department (Heck & Hallinger, 2010). In addition, acting ensures what was learned can be transferred to other departments and used as the basis of change (Langley et al., 2009; Jeske et al., 2006). The test is done to predict the expected improvement based on the project requirements. In addition, it increases the changing belief, and it evaluates the side effects and costs. The test provides learning in adapting to the local environment (Hoyt & Gopal‐Agge, 2007; Litaker et al., 2006). Minimization of the resistance during implementation can be avoided by performing tests (Tomolo, Lawrence & Aron, 2009). The components that make up the Model for Improvement provide a mechanism for achieving identified goals (Tomolo, Lawrence & Aron, 2009). It defines the phases and approaches that actualize a given strategy (Randolph et al., 2009). The Model for Improvement starts with the objective of the entire strategy, followed by approaches of arriving at the conclusion and measures that can be used to determine whether the outcomes at different stages are achieved (Janes & Mullan, 2007). The second phase is the use of PDSA in which the quality improvement strategy is used to improve the quality of the defined program (Campbell et al., 2009). PDSA has numerous stages in which each stage has specific requirements and final expectations. Therefore, Model for Improvement is a crucial component of change management in the health sector (Langley et al., 2009). Application of Model for Framework in the Surgical Department Reducing Surgical Site Infections through the Model for Improvement Introduction Hospital acquired infections signify high healthcare costs, mortality, causing increased injury and patient safety concern (Muntlin, Carlsson & Gunningberg, 2010). The purpose of this project is to reduce the occurrence of postoperative surgical site infections (SSIs) (Janes & Mullan, 2007; Jeske et al., 2006). The program called Surgical Infection Prevention Project focuses on prevention of SSIs through the improvement of the selection and timing of the administration of prophylactic antibiotic (Moen & Norman, 2010; Siassakos et al., 2010). The surgical procedures that are targeted are abdominal or vaginal hysterectomy, knee or hip replacement, vascular and cardiothoracic surgery (Tomolo, Lawrence & Aron, 2009). Forming the Team The team members are formed from a multidisciplinary perspective that includes the chief of CRNAs, safety personnel, an epidemiologist, an anesthesiologist and two surgeons (Randolph et al., 2009). The teams established measurable goals and also set the parameters, and were able to identify the objectives (Janes & Mullan, 2007; Litaker et al., 2006). Since the analysis is premised on prophylaxis, patients using other antibiotic medications will not be allowed to participate (Langley et al., 2009). The team will be able to address different factors in ensuring the medication requirement is achieved (Heck & Hallinger, 2010). The team will also be required to advise in some of the stages of the process since the team members have practical experience in the medical industry (Hoyt & Gopal‐Agge, 2007; Jeske et al., 2006). Setting Aims The aims are what should be obtained at the end of the quality management period (Hoyt & Gopal‐Agge, 2007). The aims are different and are based on population and other factors that guide the medically based requirements (Tomolo, Lawrence & Aron, 2009; Litaker et al., 2006). The following are the aims of the current study: Reduce the number of SSIs infection by 20% based on the previous six months recorded errors The project will take place for the next six months, but monthly review will be commissioned to understand the progress (Heck & Hallinger, 2010) A target sample of a minimum of 30 patients per month and within the six months 180 patients should have passed through the system. The aims set what shall be achieved at the end of the quality improvement period (Muntlin, Carlsson & Gunningberg, 2010; Taylor et al., 2013). The final analysis should be based on the stated objectives or aims. Establishing Measures The measures for the antibiotic administration are: The dosage of antibiotic should be specific to the surgery (Randolph et al., 2009) The dose is administered within 0-60 minutes before incision The administration should be based on weight to determine the right dosage If the surgery is longer that 240 minutes, appropriate intra-operative re-dose Prophylactic should be discontinued within twenty-four hours after surgery The Model for Improvement is to limit chances of occurrence of defects or errors to 20% from the current rate of 50%. Selecting Changes The following are some of the approaches employed to address the SSIs complexities within the surgery and during the surgery: Administering antibiotics within an hour before surgical incision (Sajadi et al., 2006) The recommendations should be consistent with prophylactic antibiotic The antibiotics prophylactic antibiotics should be discontinued within twenty-four hours after the surgery These are the important strategies towards changes and identify how the changes will qualify. It determines cutoff components and ensures a measurable approach is employed (Muntlin, Carlsson & Gunningberg, 2010). Without definite approach, the outcome will be ambiguous. Therefore, these three changes should be championed. Testing Changes The changes shall be analyzed based on predictions and aims (Randolph et al., 2009). The changes should be analyzed based on the aims, and the measurements should be based on changes. For example, calculations are done to ensure the final monthly estimation and average six-month estimation is less than 20% and other measurement factors are as stated (Tomolo, Lawrence & Aron, 2009; Litaker et al., 2006). In addition, the medication should have assisted the patients and complications and challenges should be record with the purpose of arriving at an informed conclusion (Hoyt & Gopal‐Agge, 2007; Siassakos et al., 2010). Implementing Changes A rooster will be kept, and records made to determine to monitor the way the project continues (Muntlin, Carlsson & Gunningberg, 2010). The changes will start on 1st April, 2015, and will carry on for the next six months. The surgeons and other people within the surgery will be required to record the information based on medication, when the medication was provided and whether it was discontinued after twenty-four hours (Hoyle, Samek & Valois, 2008). After each month, the data is reviewed and determined whether it meets the predetermined requirements (Tomolo, Lawrence & Aron, 2009; Litaker et al., 2006). After six months, the data is reviewed and compared with the predictions with the purpose of determining the success of the prediction (Siassakos et al., 2010; Jeske et al., 2006). The team members will be required to record their diverse views and experience during the period since the information will be used to understand the context (Heck & Hallinger, 2010). Spreading Changes The review of the data and the outcome of the quality and change management provide recommendations that can be used to improve other sectors (Randolph et al., 2009; Reid, 2006). The changes and predictions are compared and determine whether the change has improved the business operations of the health facility (Nazemi, 2010; Litaker et al., 2006). The outcome is used to improve other sectors within the hospital setting because the approach has been tested and approved (Tomolo, Lawrence & Aron, 2009; Jeske et al., 2006). For example, the “Reducing Surgical Site Infections through the Model for Improvement” study can be replicated to other surgical sites to reduce or eliminate changes of errors (Shams & Golshiri, 2005). Conclusion Model for Improvement and PDSA cycle is important in improving quality and championing management change. The Model for Improvement has two stages, one which addresses the aims, measures and change. The second stage is the PDSA cycle that incorporates a plan, do study and act. These components complement each other to ensure the healthcare operates effectively, and change is embraced within the health department. An example is the surgery where there are numerous errors related complaints and the use of Model for Improvement would address the problem. With the changes, the changes can be introduced into different departments within the hospital setting. It will lay the ground for change and can reverberate to other sectors in the industry. It is also important to note there are additional models that apply to different circumstances based on the scenario. This is a single scenario where the Model for Improvement has been employed and mostly likely will be successful based on the methodology employed. References Berry, S. A., Doll, M. C., McKinley, K. E., Casale, A. S., & Bothe, A. (2009). ProvenCare: quality improvement model for designing highly reliable care in cardiac surgery. Quality and Safety in Health Care, 18(5), 360-368. Campbell, S. M., Reeves, D., Kontopantelis, E., Sibbald, B., & Roland, M. (2009). Effects of pay for performance on the quality of primary care in England. New England Journal of Medicine, 361(4), 368-378. Dunsford, J. (2009). Structured communication: improving patient safety with SBAR. Nursing for Women's Health, 13(5), 384-390. Gillam, S., & Siriwardena, A. N. (2013). Frameworks for improvement: clinical audit, the plan–do–study–act cycle and significant event audit. Quality in Primary Care, 21(2), 123-130. Heck, R. H., & Hallinger, P. (2010). Testing a longitudinal model of distributed leadership effects on school improvement. The Leadership Quarterly, 21(5), 867-885. Hoyle, T. B., Samek, B. B., & Valois, R. F. (2008). Building capacity for the continuous improvement of health‐promoting schools. Journal of School Health, 78(1), 1-8. Hoyt, L., & Gopal‐Agge, D. (2007). The business improvement district model: A balanced review of contemporary debates. Geography Compass, 1(4), 946-958. Hwang, Y. D., Wen, Y. F., & Chen, M. C. (2010). A study on the relationship between the PDSA cycle of green purchasing and the performance of the SCOR model. Total Quality Management, 21(12), 1261-1278. Janes, G., & Mullan, A. (2007). Service improvement: Gillian Janes and Aidan Mullan explain why service improvement should concern all healthcare staff. Nursing Management, 14(6), 22-25. Jeske, L., Kolmer, V., Muth, M., Cerns, S., Moldenhaur, S., & Hook, M. L. (2006). Partnering with patients and families in designing visual cues to prevent falls in hospitalized elders. Journal of Nursing Care Quality, 21(3), 236-241. Kyrkjebø, J. M., & Hage, I. (2005). What we know and what they do: nursing students’ experiences of improvement knowledge in clinical practice. Nurse Education Today, 25(3), 167-175. Langley, G. J., Moen, R., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: a practical approach to enhancing organizational performance. John Wiley & Sons. Langley, G. J., Moen, R., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: a practical approach to enhancing organizational performance. John Wiley & Sons. Langley, G. J., Moen, R., Nolan, K., Nolan, T., Nomran, C., & Provost, L. (2009). Using the model for improvement. The improvement guide: A practical approach to enhancing organizational performance. Oxford: Oxford University Press. Litaker, D., Tomolo, A., Liberatore, V., Stange, K. C., & Aron, D. (2006). Using complexity theory to build interventions that improve health care delivery in primary care. Journal of General Internal Medicine, 21(S2), S30-S34. Moen, R. D., & Norman, C. L. (2010). Circling back. Quality Progress, 43(11), 22-28. Muntlin, Å., Carlsson, M., & Gunningberg, L. (2010). Barriers to change hindering quality improvement: the reality of emergency care. Journal of Emergency Nursing, 36(4), 317-323. Muntlin, Å., Carlsson, M., & Gunningberg, L. (2010). Barriers to change hindering quality improvement: the reality of emergency care. Journal of Emergency Nursing, 36(4), 317-323. Nakajima, K., Kurata, Y., & Takeda, H. (2005). A web-based incident reporting system and multidisciplinary collaborative projects for patient safety in a Japanese hospital. Quality and Safety in Health Care, 14(2), 123-129. Nazemi, J. (2010). A process model for improvement through EFQM. World Applied Sciences Journal, 8(3), 279-287. Oyler, J., Vinci, L., Arora, V., & Johnson, J. (2008). Teaching internal medicine residents quality improvement techniques using the ABIM’s practice improvement modules. Journal of General Internal Medicine, 23(7), 927-930. Peden, C. J., & Rooney, K. D. (2009). The science of improvement as it relates to quality and safety in the ICU. Journal of the Intensive Care Society, 10(4), 260-265. Randolph, G., Esporas, M., Provost, L., Massie, S., & Bundy, D. G. (2009). Model for improvement-part Two: measurement and feedback for quality improvement efforts. Pediatric Clinics of North America, 56(4), 779-798. Reid, R. A. (2006). Productivity and quality improvement: an implementation framework. International Journal of Productivity and Quality Management, 1(1), 26-36. Sajadi, A., Bensadoun, J. C., Schneider, B. L., Bianco, C. L., & Aebischer, P. (2006). Transient striatal delivery of GDNF via encapsulated cells leads to sustained behavioral improvement in a bilateral model of Parkinson disease. Neurobiology of Disease, 22(1), 119-129. Shams, B., & Golshiri, P. (2005). Presenting a model for improvement of nutrition and growth promotion of children by the CIPP Evaluation Model in Isfahan. Iranian Journal of Pediatrics, 15(3), 221-228. Siassakos, D., Fox, R., Hunt, L., Farey, J., Laxton, C., Winter, C., & Draycott, T. J. (2010). Attitudes toward safety and teamwork in a maternity unit with embedded team training. American Journal of Medical Quality, 1062860610373379. Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2013). Systematic review of the application of the plan–do–study–act method to improve the quality in healthcare. BMJ quality & safety, bmjqs-2013. Tomolo, A. M., Lawrence, R. H., & Aron, D. C. (2009). A case study of translating ACGME practice-based learning and improvement requirements into reality: systems quality improvement projects as the key component to a comprehensive curriculum. Quality and Safety in Health Care, 18(3), 217-224. Read More