Quality improvement can be accomplished using the planned change process. In planning for change, professional nurses use a structured process to assess aspects of the change, to carefully consider the culture or work climate affected by the proposed change, to figure out how to introduce the change, and, then, how to evaluate the change. Engaging in the planned change process is the key to a successfully implemented quality improvement project. It is a strategy used by many businesses and professions world-wide. And as a professional nurse, this can be a key strategy for gaining control over your professional practice environment. Chapter 8 in the text describes the process of planned change, and Chapter 23 describes quality control – activities that are used to evaluate, monitor, or regulate services we provide to our patients.
The purpose of this assignment is to identify a patient care issue in the organization where you work that could be improved in order to increase the quality of care. For example, do you want to decrease patient falls or medication errors, reduce the incidence of ventilator-associated pneumonia or UTIs, assess for delirium, or respond to signs of patient deterioration? Your topic should be one that has some evidence for “research-based best practices.” Quality improvement change must be supported by evidence, similar to evidence-based practice, but here the focus is on the process undertaken for improvement. The diagram shows how evidence supports both QI and EBP.
In order to find topics with support from research, try research guides such as this one on the EPC Evidence-Based ReportsLinks to an external site. (http://www.ahrq.gov/research/findings/evidence-based-reports/index.html) page of the AHRQ website.
Resources
To help you select a topic, consider the following:
The Agency for Healthcare Research and Quality is a wonderful resource to explore resources delivering safe, high-quality care to patients in all clinical settings. A good page to start on is the QI Guide on Improved Nursing CareLinks to an external site. (https://www.ahrq.gov/professionals/systems/monahrq/myqi/nursing.html).
If you work in a skilled nursing facility or nursing home, you may wish to select your topic based on one of the Minimum Data Set quality indicators from the Nursing Home Quality Initiative. Current nursing home quality measures can be found half way down on this page: Quality MeasuresLinks to an external site. (https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/nursinghomequalityinits/nhqiqualitymeasures.html).
If you’re interested in the NDNQI Nursing-Sensitive Indicators, you can find a list of those indicators here: NDNQI Nursing-Sensitive IndicatorsLinks to an external site. (https://nursingandndnqi.weebly.com/ndnqi-indicators.html).
Other organizations that help identify, monitor, and evaluate quality or provide resources include:
American Nurses Association’s Standards of Nursing Practice
Agency for Healthcare Research and Quality (AHRQ)
Center for Disease Control (CDC)
Centers for Medicare and Medicaid Services (CMS)
Institute for Healthcare Improvement (IHI)
Joint Commission (JC)
National Database of Nursing Quality Indicators (NDNQI)
Quality and Safety Education for Nurses (QSEN)
Grading and Structure
Because this is a three-credit course without examinations, the Quality Improvement Project accounts for 35 percent of your grade. Keep in mind that, although we ask you to take the paper through the entire process, it is not an expectation of this course for you to implement your change. Why? Because most change processes require a year or more to get through the evaluation phase, and we have only a limited time together in this class.
Write your paper using APA format (utilize headings), with a minimum of 4 references from peer-reviewed journal articles/primary sources for rationale. Search on CINAHL for key terms for your topic. Your paper should be free of grammatical and typographical errors (including spelling). Students who seek an “A” on this improvement project will have a minimum of 8 to 10 primary source references (some of you may have more). Note that this paper should include the following (in this order):
Title page
Executive summary
Introduction
Four phases of the project that were developed over the semester
Summary or conclusion
Reference list
To get the most from this course, and to help you achieve the level of quality required, you may want to work with the writing center on your campus as you begin to plan and compose the first drafts of your writing assignments.
Step 1. Phase 1 includes an introduction, strategic assessment, and a SWOT analysis.
Introduction: Identify your topic and your rationale for choosing the topic.
What is a strategic assessment? It’s a summary of the “present situation.” It describes the unit, organization, or work group’s characteristics. Include information about structure and mission of your organization, the type of administrative structure, the population served, and the cultural climate for your proposed change.
What is a SWOT Analysis? It is an evaluation of the Strengths and Weakness and the Opportunities and Threats of the planned change. Describe and provide supporting data or examples.
Any sources you provide must be primary sources.
Identify your topic for this change project and describe the rationale for making this change. Why it is needed? How will the organization, unit, or practice be better after making this change? How will patient care be improved? (This is where data from your strategic assessment is pertinent.) Research the professional peer-reviewed literature in order to document the support for your idea for change. This part of your paper should be well-referenced and provide evidence for your evidence-based practice change.
Describe your plan for change. What steps do you propose? Who will be involved in the change process? What are the goals to be accomplished? What is the timeline of the change process? If you have a protocol or assessment tool that will be implemented as part of the change process, include copies in an appendix to your paper if they are available.
Discuss financial considerations and feasibility of the proposed change.
Strategies for Implementing Change: Now your plan is ready to be implemented. How will you make this change happen? Strategies for implementing change can be especially strong if they are based on change theory (such as the Lewin’s Change Theory or the Theory of Diffusion of Innovation). The implementation strategies need to be based on what the professional literature and/or your textbooks tell you. Be sure to use library resources for this phase of your project. Consider the following:
Teaching and informational materials for the group of interest
Motivational strategies
Tactics to decrease expected resistance
Inclusion, involvement, and participation of persons affected
Assignment of responsibility (if a person other than you will be the change agent)
Normative/re-educational or power/coercive strategies
For each activity, provide your rationale. How will this activity contribute to making the change and/or achieving the goal? As you plan your strategies, you may need to revise your timeline.
Discuss your plans for ensuring that this change will become institutionalized. How will you prevent members of the target group from “backsliding” – from reverting to their pre-change way of functioning? Consider the following:
Changes needed in personnel policies (for example, job descriptions, flow sheets, evaluations, expected competencies, and rewards)
Communication among departments, within departments, and along the chain of command (either about the change or required by the change)
Inclusion of innovation/change in regular reporting mechanisms, verbal and written
Implications for written policies or procedures for patient care, documentation, or audit mechanisms
Describe how you will assess whether the change has been successfully completed. What behaviors and/or attitudes will be present in the target population? What will evaluation mechanisms show?
The executive summary of your quality improvement project replaces the abstract. It should provide enough information for the reader to know the focus of the project, implementation strategies, intended outcomes, and any setting or target group characteristics that need to be uniquely considered. Your executive summary should give the reader a complete enough picture to understand your proposal, but without detail. The expectation is that if additional information is desired the reader will either continue and read the total report or contact the writer.
The executive summary for your paper is a synopsis of your paper. Include the important highlights. Limit your executive summary to 1000 words (2-4 pages).
Make the four sections of your paper and executive summary and create a formal, end-of-semester “term paper,” completed in APA format and with supporting primary source references. The executive summary, the introduction with the body of the paper, and the references should all start on new pages. The executive summary follows the title page and replaces the abstract. You may include appendices after the references. Appendices could include things like an assessment tool, a protocol, or a tool for outcome measurement.
Your final paper should be free of grammatical errors, properly cited, and in compliance with APA style. You must use headings/heading levels in your paper. Please refer to the APA manual for the format of levels of headings. Please use primary sources only. Websites are not acceptable.
Submit the final Quality Improvement Project paper as an attachment by the date indicated in the course calendar. As a general guideline, each of the four phases of the paper should be approximately 2-4 pages in length.
Paper Components
The components of the Quality Improvement Project paper are weighted as follows:
Executive Summary – 10 points
Strategic Assessment – 20 points
Change & Rationale – 25 points
Implementation – 15 points
Stabilizing & Evaluation – 20 points
APA – 10 points
Maximum total grade points: 100
Grading Criteria
Evaluation of the Quality Improvement Project paper uses the following criteria:
Quality Improvement Project Rubric
1. Executive Summary
Very Good to Exceptional
(9-10 pts.)
In place of an abstract, this provides enough information about the project so the reader can understand the proposal, but without detail. Should include the project focus, implementation strategies, and intended outcomes. Between 1-2 pages in length. Satisfactory
(7-8 pts.)
Assignment guidelines followed. Provides either too much or not enough information about the project; does not entice the reader to continue reading. Marginally Acceptable
(5-6 pts.)
Very brief or short summary of the project and does not depict what the project is about. Assignment guidelines not followed. Completely or Mostly Unacceptable
(0-4 pts.)
No executive summary included or is less than one half page in length and does not include information about project. ___/10
2. Strategic Assessment
Very Good to Exceptional
(18-20 pts.)
Assignment guidelines clearly followed. Includes introduction with topic and rationale for project. Unit, organization, or work groups characteristics described clearly so reader can picture the situation. SWOT analysis evident of thorough review. Satisfactory
(15-17 pts.)
Assignment guidelines followed. Strategic assessment leaves reader with a few questions about situation. Unit, work group, or organization, characteristics described. Marginally Acceptable
(11-14 pts.)
Assignment guidelines followed marginally. Unit, organization, or work group characteristics briefly described, but leaves reader with many questions of situation. Completely or Mostly Unacceptable
(0-10 pts.)
Assignment guidelines not followed. Unit, organization, or work group not well described. Reader does not have clear picture of situation. ___/20
3. Change and Rationale
Very Good to Exceptional
(22-25 pts.)
Assignment guidelines clearly followed. Change or improvement described clearly and thoroughly. Goals, target group, and timeline feasible and reasonable for project. Evident that financial implications were considered. Robust rationale from literature clearly identified and supports the described changed or improvement being proposed. Minimum of 4 peer-reviewed journal articles. Satisfactory
(18-21 pts.)
Assignment guidelines followed. Change or improvement described adequately, but leaves reader with some questions. Goals, target group, and timeline described and reasonable. Financial considerations included. Rationale adequate to support change. Marginally Acceptable
(14-17 pts.)
Assignment guidelines followed marginally. Change or improvement described incompletely. Goals, target group, timeline not clearly identified or appropriate. Financial considerations minimally addressed. Some rationale to support project included. Completely or Mostly Unacceptable
(0-13 pts.)
Assignment guidelines not followed. No change or improvement identified. No goals, target group, timeline, financial considerations, or rationale included. ___/25
4. Implementation
Very Good to Exceptional
(14-15 pts.)
Assignment guidelines clearly followed. Theory of change identified and strategies based on literature with references included. Clear description of teaching materials, motivational strategies, resistance tactics, involvement of people, and assignment of responsibility included with rationale from literature. Implementation strategies feasible and reasonable. Satisfactory
(12-13 pts.)
Assignment guidelines followed. Strategies for implementing identified and include teaching materials, motivational strategies, resistance tactics, and description of responsibility for those involved. Some literature to support strategies included. Marginally Acceptable
(8-11 pts.)
Assignment guidelines followed marginally. Some description of how change will be implemented, but leaves reader with many questions or is not appropriate for proposed change. No literature to support implementation strategies. Completely or Mostly Unacceptable
(0-7 pts.)
Assignment guidelines not followed. Minimal description of how change will be implemented. ___/15
5. Stabilizing and Evaluation
Very Good to Exceptional
(18-20 pts. )
Assignment guidelines clearly followed. Outcome measures clearly identified and include financial considerations. Data collection, frequency, and reporting are described. Additional considerations included, such as policy change, communication, and ongoing review to keep change or improvement moving forward and prevent backsliding. Also included is discussion of how the change will be assessed and whether successful.
Excellent conclusion, fully brings paper together. Satisfactory
(15-17 pts. )
Assignment guidelines followed. Outcome measures identified, but not as clear. Minimal financial considerations included. Data collection, frequency, and reporting are included, but minimally described. Policy change, communication, ongoing review, and assessment of change is minimally described.
;Conclusion addresses some components of the paper but does not fully bring the paper together. Marginally Acceptable
(11-14 pts. )
Assignment guidelines followed marginally. Outcome measures not clearly identified. No financial considerations. Data collection, frequency, and reporting minimized. Policy change, communication, ongoing review, and assessment of change included, but minimal and/or missing an aspect.
Minimal conclusion, does not fully bring the paper together Completely or Mostly Unacceptable
(0-10 pts. )
Assignment guidelines not followed. Outcome measures not identified. No financial considerations. Minimal description of data collection, frequency, reporting, policy change, communication, ongoing review, and assessment of change included, but missing several aspects.
No conclusion. ___/20
6. APA
Very Good to Exceptional
(9-10 pts. )
Title page formatted correctly. Headings used appropriately. No spelling or grammar errors. APA formatted correctly. Reference page double-spaced with hanging indent and formatted correctly. Satisfactory
(7-8 pts.)
A few spelling or grammar errors noted throughout the paper. A few APA style issues with spacing or formatting noted. Reference page with some formatting errors. Marginally Acceptable
(5-6 pts.)
Many spelling or grammar errors throughout the paper. Many APA style or formatting issues noted throughout the paper or reference page. Completely or Mostly Unacceptable
(0-4 pts.)
APA style not followed. Many spelling or grammar errors prevalent.
