Data Analysis and Quality Improvement Initiative Proposal

Instructions:   Prepare an 8-page data analysis and quality improvement initiative proposal based on a health issue of professional interest to you. The audience for your analysis and proposal is the nursing staff and the interprofessional team who will implement the initiative.

"A basic principle of quality measurement is: If you can't measure it, you can't improve it" (Agency for Healthcare Research and Quality, 2013).

Health care providers are on an endless quest to improve both care quality and patient safety. This unwavering commitment requires hospitals and care givers to increase their attention and adherence to treatment protocols to improve patient outcomes. Health informatics, along with new and improved technologies and procedures, are at the core of virtually all quality improvement initiatives. The data gathered by providers, along with process improvement models and recognized quality benchmarks, are all part of a collaborative, continuing effort. As such, it is essential that professional nurses are able to correctly interpret, and effectively communicate information revealed on dashboards that display critical care metrics.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 2: Plan quality improvement initiatives in response to routine data surveillance.

• Outline a QI initiative proposal based on a selected health issue and supporting data analysis.

• Competency 3: Evaluate quality improvement initiatives using sensitive and sound outcome measures.

• Analyze data to identify a health care issue or area of concern.

• Competency 4: Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work-life quality.

• Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work-life quality.

• Competency 5: Apply effective communication strategies to promote quality improvement of interprofessional care.

• Apply effective communication strategies to promote quality improvement of interprofessional care.
• Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.

Reference

Agency for Healthcare Research and Quality. (2013). Preventing falls in hospitals. Retrieved from https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtk5.html#tiptop

Questions to Consider

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

Reflect on QI initiatives focused on measuring and improving patient outcomes with which you are familiar.

• How important is the role of nurses in QI initiatives?
• What quality improvement initiatives have made the biggest difference? Why?
• When a QI initiative does not succeed as planned, what steps are taken to improve or revise the effort?

Assessment Instructions

Preparation

In this assessment, you will propose a quality improvement (QI) initiative proposal based on a health issue of professional interest to you. The QI initiative proposal will be based on an analysis of dashboard metrics from a health care facility. You have one of two options:

Option 1

If you have access to dashboard metrics related to a QI initiative proposal of interest to you:

• Analyze data from the health care facility to identify a health care issue or area of concern. You will need access to reports and data related to care quality and patient safety. If you work in hospital setting, contact the quality management department to obtain the data you need.
• You will need to identify basic information about the health care setting, size, and specific type of care delivery related to the topic that you identify. You are expected to abide by HIPAA compliance standards.

Option 2

If you do not have access to a dashboard or metrics related to a QI initiative proposal:

• You may use the hospital data set provided in the media piece titled Vila Health: Data Analysis. You will analyze the data to identify a health care issue or area of concern.
• You will follow the same instructions and provide the same deliverables as your peers who select Option 1.

Instructions

Analyze dashboard metrics related to the selected issue.

• Provide the selected data set in the proposal.

• Assess the stability of processes or outcomes.
• Delineate any problematic variations or performance failures.

• Evaluate QI initiatives on the selected health issue with existing quality indicators from other facilities, government agencies, and non-governmental bodies on quality improvement.

• Analyze challenges that meeting prescribed benchmarks can pose for a heath care organization and the interprofessional team.

• Outline a QI initiative proposal based on the selected health issue and data analysis.

• Identify target areas for improvement.
• Define what processes can be modified to improve outcomes.
• Propose strategies to improve quality.
• Define interprofessional roles and responsibilities as they relate to the QI initiative.
• Provide recommendations for effective communication strategies for the interprofessional team to ensure the success of the QI initiative. Briefly reflect on the impact of the proposed initiative on work-life quality of the nursing staff and interprofessional team.

• Integrate relevant sources to support arguments, correctly formatting citations and The numbered points below correspond to grading criteria in the scoring guide. The bullets below each grading criterion further delineate tasks to fulfill the assessment requirements. Be sure that your Quality Improvement Initiative Evaluation addresses all of the content below. You may also want to read the scoring guide to better understand the performance levels that relate to each grading criterion.

1. Analyze data to identify a health care issue or area of concern.

• Identify the type of data you are analyzing (from your institution or from the media piece).
• Discuss why the data matters, what it is telling you, and what is missing.
• Analyze dashboard metrics and provide the data set in the proposal.
• Present dashboard metrics related to the selected issue.
• Delineate any problematic variations or performance failures.
• Assess the stability of processes or outcomes.
• Evaluate the quality of the data and what can be learned from it.
• Identify trends, outcome measures and information needed to calculate specific rates.
• Analyze what metrics indicate opportunities for quality improvement.

1. Outline a QI initiative proposal based on a selected health issue and supporting data analysis.

• Identify benchmarks aligned to existing QI initiatives set by local, state, or federal health care policies or laws.
• Identify existing QI initiatives related to the selected issue, and explain why they are insufficient.
• Identify target areas for improvement, and define what processes can be modified to improve outcomes.
• Propose evidence-based strategies to improve quality.
• Evaluate QI initiatives on the selected health issue with existing quality indicators from other facilities, government agencies, and non-governmental bodies on quality improvement.
• Analyze challenges that meeting prescribed benchmarks can pose for a heath care organization and the interprofessional team.

1. Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work-life quality.

• Define interprofessional roles and responsibilities as they relate to the data and the QI initiative.
• Explain how you would you make sure that all relevant roles are fully engaged in this effort.
• Explain what non-nursing concepts would you incorporate into the initiative?
• Identify how outcomes to measure the effect of the intervention affect the interprofessional team.
• Briefly reflect on the impact of the proposed initiative on work-life quality of the nursing staff and interprofessional team. Describe how work-life quality is improved or enriched by the initiative.

1. Apply effective communication strategies to promote quality improvement of interprofessional care.

• Identify the kind of interprofessional communication strategies that will be effective to promote and ensure the success of this performance improvement plan or quality improvement initiative.
• In addition to writing, identify communication models (like CUS, SBAR) that you would include in your initiative proposal.

1. Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
2. Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.

Submission Requirements

• Length of submission: 8 double-spaced, typed pages, not including title and reference page.
• Number of references: Cite a minimum of five sources (no older than seven years, unless seminal work) of scholarly, peer-reviewed, or professional evidence that support your evaluation, recommendations, and plans.

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Data Analysis and Quality Improvement Initiative Proposal Sample

Introduction

Quality improvement has now become the driving force in health care and is an essential component of service delivery at all levels. However, unless measured, it is not easy to know the exact issues that needs improvement. Reliable data must be the driving factor towards systems and process improvement. Data enables us to identify problems accurately; it also helps prioritize quality improvement initiatives and enables an objective assessment of whether change and improvement have occurred. A central function to quality improvement is thus the collection and analysis of data in any health facility. 

Health workers including nurses have a crucial role to play towards achieving quality improvement objectives and initiatives in health facilities across the globe. Nurses frequently interact with patients and are familiar with their most immediate needs thus making them key personnel in organizational efforts towards improving the quality of care. 

Dashboard metrics are critical in any healthcare facility because they help in identifying the various challenges in the institution and act as the foundation of all initiatives aimed at quality improvement (Gupta & Kaplan, 2020). Quality improvement is an approach used in healthcare facilities to identify the weak links and strategize on increasing patients’ satisfaction through high quality care provision. This paper analyzes the Vila Health dashboard which provides a series of the hospice information between 2014 and 2015. The information provided by the dashboard outlines the events that were considered as threats to patients. The indicators of quality outlined in the report include the duration of stay, symptoms, inpatient unit, and the severity of pain.

Analyzing the dashboard metrics

Physicians and nurses in healthcare facilities are expected to provide a-maximum attention and care to patients in hospice care. The hospital quality level is determined by the type of care that is provided to vulnerable patients. This can be used as an indicator of the hospital’s quality standard (Huddart et al, 2015). The hospice continuum of care is led by an interdisciplinary team of professionals including physicians, ancillary, therapist, nurses, and pharmacists who collaborate to ensure the patient's safety and comfort is prioritized.

The data collected between 2014 and 2015 at the Vila Health's hospice initiative was used to evaluate the patients care. Various variables were obtained from the data; for instance, the level of pain that lasted for more than 24hrs that was between seven and ten, the duration of patients' stay, hospital admission, and inadequate symptom relief proceeded beyond twenty-four hours. Both the nurses and the interprofessional were interviewed with the aim of outlining the quality improvement initiative proposal.

Use of Data Analytics to Identify an Issue 

Most clients of Vila Health's offsite hospice program receive care from their homes, and in severe cases, short inpatient admissions can be provided. The interdisciplinary team of professionals is responsible for providing emotional, psychological, and spiritual, needs to patients and their immediate relatives at the end of a patient's life.  Vila Health facility outlined several adverse events that were reported between 2014 and 2015. The indicators include the duration of stay in the facility, the number of inpatient admissions received, the levels of pain above seven for more than twenty-four hours, and finally, the inadequate symptom relief for more than twenty-four hours (Cole et al, 2015). This data will be used as the basis for the outline of the facility's quality improvement initiative proposal to increase the quality of care provided to a hospice patient and family members for end-of-life care.

Table 1: Hospice Adverse Event Data 2014-2015

Unit-Year	LOS less than 7 days	IPU Admission	Pain-Level 7-10 more than 24hours	Inadequate symptom relief more than 24 hours
Hospice 2014	50	47	13	13
Hospice 2015	46	27	17	22

The above table reflects the data released by Vila Health, with a total number of adverse events reported having decreased from one hundred twenty-three to one hundred twelve from 2014 to 2015, respectively. Length of stay and inpatient admissions decreased from fifty to forty-six and forty-seven to twenty-seven, respectively. An increase in pain levels ranging from seven to ten for more than twenty-four hours were observed between 2014 and 2015 with reported adverse events of thirteen and seventeen (Shalev et al, 2019). Vila Health’s hospice unit also reported an increase in reported adverse events for inadequate symptom relief for more than twenty-four hours with thirteen in 2014 and twenty-two in 2015. The information that was reported by Vila Health is extremely important information for the healthcare team at Vila Health and the patients that it serves as it relates to the quality of care that is being provided. Vila Health’s David Brooks said the number of adverse events reflected the quality of care that Vila Health’s healthcare team members were providing. Brooks explained that if only prevention of adverse events was being performed then quality care was not being delivered to the hospice patients.

The data provided by Vila Health shows the areas that were improved upon, length of stay and number of admissions. The categories consisting of pain levels and symptom management reveals quality of care decreased from 2014 to 2015. Collecting this data demonstrates the pain levels and symptom management indicators are what Vila Health should focus their quality improvement initiatives on. More detailed data would greatly improve any quality improvement initiative that can be started. Gathering information regarding why these numbers increased would help direct a QI project and tailor it to what is needed to be more successful. Vila Health should provide information on experience levels of the registered nurse (RN), how many patients each RN is caring for, delays due to communication failures, and drive time of the RN to better understand why quality of care decreased between 2014 and 2015. Vila Health is limited on some data (Gomez et al, 2014). The Chief Financial Officer of Vila Health explained that unless the registered nurses report concerns Vila Health does not know if there are problems. The quality of the data can be limiting, as with any reporting system it relies on team members to be truthful and report each event. Reporting an event may be limited because it could be felt to be too time consuming by the team member or the team member may feel it would be an indicator of their own job performance. It is important to evaluate the work environment and ensure a supportive setting is provided for team members to be comfortable reporting adverse events to be learned from. It can be concluded based on Table 1 that the metrics of high pain levels and inadequate symptom relief indicate opportunities for quality improvement at Vila Health. These metrics will be the focus of the proposed quality improvement initiative.

Quality Improvement Initiative Proposal

Centers for Medicare and Medicaid Services sets forth a set of quality indicators and benchmarks that healthcare institutions must abide to be appropriately reimbursed. CMS lists multiple required measures, including pain screenings within two days of hospice admission, pain assessments and treatment within one day of a positive pain screening, and dyspnea treatment within one day of positive screening. Currently Vila Health’s offsite hospice unit does not meet those standards with thirteen adverse events reported for both high pain level and inadequate symptom management categories in 2014. 2015 data reflects the same negativity with seventeen adverse events related to pain levels and twenty-two related to inadequate symptom management. Due to the adverse events related to pain relief and symptom management, these two benchmarks will be the target areas for improvement in the quality improvement initiative. Processes will be modified to improve outcomes. 

One process that will be modified to make improvements is how nursing communicates with hospice physicians. Per the CFO, current technology is laptops with access to the electronic health record. Multiple studies have shown telemedicine, or video conferencing technology, can be used to make higher quality of care available due having access to a physician sooner to obtain orders for pain and other symptoms. Telemedicine does have drawbacks with access and cost of this technology and the attitude directed to video versus a physical presence of a healthcare provider (Pottie et al, 2014). The quality improvement initiative will use the Six Sigma framework that evaluates concerning areas and mistakes on processes already in place. This will help Vila Health be cost-effective while improving quality of care. 

Using Six Sigma will also elaborate further on comments made by the CFO that nursing is not reporting all that is wrong or concerning to them. Six Sigma will help create an inviting and honest environment that will allow nurses’ concerns to be heard, therefore, making them feel valued. The CFO also reported staff may be having issues with traveling long distances and having too large of a patient assignment. Six Sigma frameworks will be used to evaluate how that can be improved and generate other ideas to adjust the processes Vila Health already has in place. Challenges are present that prevent Vila Health and its interprofessional team from meeting the set benchmarks set by the Centers for Medicare and Medicaid Services. 

Available resources allocated to Vila Health’s offsite hospice unit may be limiting due to cost and current staff availability may prevent some parts of the initiative from being accepted or completed. Information that is missing that would greatly impact a quality improvement initiative is interviews with the staff members providing direct patient care. This would provide a new understanding and different viewpoints on how to improve the quality of care for Vila Health’s hospice unit.

Interprofessional Perspectives

A successful quality improvement initiative looks at all angles and includes opinions and perspectives from the entire interprofessional team that the QI project would be affecting the responsibilities of. This allows the processes to be amended with changes that have been evaluated by all team members and allowed to be introduced without major mistakes. Each interprofessional team member plays a different role. The team members include physicians, nurses, chaplains, and others depending on each patient’s individual care. 

Hospice physicians are responsible for providing orders for the other members to follow. Their role relates to the data of pain and symptom management because they give the orders that would affect that data. It is not clear as to why those benchmarks are not successful, whether it is delay in ordering medications by the physician, delay in communicating, or delay in administration by the nursing staff. The responsibilities of the nurse include managing care of the patient, following the orders written by the doctor, and communicating any issues that arise in a timely fashion. The QI initiative directly impacts both the physician and nurse as it will use the non-nursing concept of Six Sigma to see what needs changing to improve the quality of care being provided. For the effort to be successful all roles relating to the care of the patient would need to be included. Centers for Medicare and Medicaid require the hospice team to include the doctor, nurse, chaplain, and social worker. The team is required to meet once every fifteen days. Even though this is a requirement, each role needs to be fully engaged in the effort. This can be done by creating a supportive environment of equality between each party. 

An environment that respects each role will produce more ideas, interventions, and successes. This builds team morale and utilizes the strengths already employed, leading to cost-effective care. Each meeting needs to stay focused on the goal of increasing quality of care. Staying on track and on topic will be cost-effective for Vila Health. The interprofessional team is impacted individually by the outcomes used to measure the effect of the interventions because it can bring to light mistakes or low quality of care by that team member. The interventions can modify the responsibilities of the team members. Work-life quality of the nursing staff and the interprofessional team is greatly enriched by the initiative. The initiative evaluates the opinions and ideas of the team members directly involved in the hospice patient’s care. They feel valued as team members because their opinion is being heard. It allows them to identify what they need to be improved to improve the quality of care they are giving and to make their job responsibilities easier to manage. This relieves stress and creates a better work environment for the team. Less stress leads to fewer mistakes and increases quality of care.

Communication Strategies to Promote Quality Improvement of Interprofessional Care Effective communication strategies to use during team meetings that promote quality improvement of interprofessional care is an important asset to have. It will be important that each team member can talk about concerns and ideas at any given time. Respect should be shown to each person as they voice that concern. Keeping notes and track of what is talked about in the meetings are crucial to staying on task and successfully communicating. Agendas should be available at the beginning of each meeting to create a schedule and guide conversation in an order that promotes continuity and eliminates opportunities to lose focus. These strategies are based on the assumptions that a team member will be willing to provide an agenda prior to the meeting and that a team member is willing to take detailed notes to provide to the others after the meeting is completed. Vila Health’s hospice unit will utilize the CUS communication model to ensure the success of the quality improvement initiative. The CUS tool is a simple algorithm to guide communication between team members. CUS stands for concern, uncomfortable, and safety issue. This will be used by team members to evaluate what they wish to work on. It will also be used to evaluate the interventions that are suggested by the quality improvement initiative.

Conclusion 

QI projects are only successful if all interprofessional perspectives are included. Data must be collected, and standard benchmarks must be used to make comparisons to establish the success of the quality improvement initiative. Vila Health’s hospice unit collected data from the years of 2014 and 2015 from adverse events that were reported. The benchmarks they reported having adverse events about were duration of stay, inpatient admission, pain levels greater than seven for more than twenty-four hours, and insufficient sign relief for more than twenty-four hours. More information could be provided by Vila Health to create a more detailed and cost-effective QI project to increase quality of care for patients and their families at the end of life.

References

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Huddart, S., Peden, C. J., Swart, M., McCormick, B., Dickinson, M., Mohammed, M. A., ... & 

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Coles, E., Anderson, J., Maxwell, M., Harris, F. M., Gray, N. M., Milner, G., & MacGillivray, S. 

(2020). The influence of contextual factors on healthcare quality improvement initiatives: a realist review. Systematic reviews, 9, 1-22.

Shalev, A., Phongtankuel, V., Reid, M. C., Czaja, S. J., Dignam, R., Baughn, R., ... & Adelman, 

R. D. (2019). Home hospice caregivers’ perceived information needs. American Journal of Hospice and Palliative Medicine®, 36(4), 302-307.

Gómez-Batiste, X., Martínez-Muñoz, M., Blay, C., Amblàs, J., Vila, L., Costa, X., ... & Mitchell, 

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Pottie, C. G., Burch, K. A., Montross Thomas, L. P., & Irwin, S. A. (2014). Informal caregiving 

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