A brief explanation of the quality improvement model you selected, including a description of the components that make up this model.
The quality improvement model selected for this assignment is the A3 model. This model provides a very basic, yet structured approach towards problem-solving. The model was first applied by the Toyota corporation, many years ago, as a model for continuous improvement. According to UNC Institute for Healthcare Quality Improvement (2021), the model received its name, based on the type/size of the paper, A3. It is also known as SPS, which is Systematic Problem Solving and is based on the basic principles identified by Edward Demings PDCA (Plan Do Check Act) process (UNC Institute for Healthcare Quality Improvement, 2021). The A3 process involves includes a total of 11 distinct steps, including a step 0, which identifies the problem. Steps 1 – 8 are planning steps, interestingly enough, embedded in these steps are Deming’s PDCA steps. Step 9 is the do step and step 10 is the check step (Montana State University, n. d.). At the end of the cycle, any identified opportunities for improvement are identified and the cycle is initiated again.
Explain how this quality improvement model might be implemented in your healthcare organization or nursing practice in response to an adverse event requiring quality improvement. Be specific and provide examples.
At my current organization, we use the A3 method for quality improvement initiatives. We have a Lean Six Sigma Blackbelt at our organization and all of the directors and managers are at least certified Green Belts in the Lean Six Sigma training. The A3 form/format is utilized for patient-related harms reported across the organization. This primarily includes Hospital Acquired Pressure Injuries (HAPI’s), Catheter-Associated Urinary Tract Infections (CAUTI’s), and Venous Thromboembolisms (VTE’s). Although we follow a similar format previously described in the steps above for the A3, our organization asks specific questions for each step of the A3 process. This is very helpful when ensuring that clinicians do a deep dive into the reasons for the harm, as well as identifying opportunities to improve the quality of patient care and prevent further harm.
The most recent incident that we need to complete an A3 was for a harm on the Palliative Care unit. A bedridden patient developed a HAPI, a stage 2 pressure injury on their right heel (Step 0). Upon review of the chart/patient flow, staff processes/procedures (Steps 1-8), the patient was not being turned every two hours per organizational policy. It was further determined that the patient was boarded in the ED for 36 hours, prior to being admitted to the Palliative care unit. Consequently, the ED had to take responsibility for the harm, considering that the patient had only been on the Palliative care unit for less than 24 hours. Ultimately, the organization needs to ensure that all departments are following our policies related to turning identified patients, every 2 hours (Step 9). Ongoing, the Performance Excellence Committee reviews data/patient records, to ensure that there are no additional harms (Step 10). Once the A3 document is completed, it is reviewed with the harms team, and approval is sought for any changes in practice, protocol, policy, etc.
References
Montana State University (n. d.). Steps of the A3. Retrieved from https://www.montana.edu/dsobek/a3/steps.html
Tromp, R. (n. d.). A3 report. Lean Six Sigma Group. Retrieved from https://leansixsigmagroup.co.uk/a3-report/
UNC Institute for Healthcare Quality Improvement (2021). Resources: A3. Retrieved from https://www.med.unc.edu/ihqi/resources/a3/
The Plan-Do-Study-Act Cycle is the Quality Improvement Model that I have chosen for this discussion. It has been utilized for continuous improvement as described by Edwards Deming (Nash et al., 2019). This improvement model assumes that 15 percent of poor quality is due to people and 85 percent of poor quality is due to improper management, systems and processes (Nash et al., 2019).
Plan
Under this phase of the quality improvement model, we seek to understand the problem and where a gap in practice exists as well as establish an objective laying out what we are trying to accomplish. In my clinical arena, we would be collecting and analyzing data to identify where a gap exists based on the data. It is possible that we find what we least expected or that the gap exists in a different place than expected. From here we can plan how to carry out the cycle.
Do
Under this phase of the cycle, we use the gap that we’ve identified and the plan that we’ve made to educate and train staff to carry out the plan. We can start to make small scale changes and evaluate its effectiveness, challenges, and problems on a small scale to prepare for implementing in a much bigger scale.
Study/Check
In this phase of the quality improvement model, we evaluate the effects of the change and decide if it was successful or not. We evaluate whether and to what degree success was obtained or did the gap get larger. Here we can determine what changes need to be made and what steps should be taken next to achieve the objective that was set during the initial plan phase of the cycle.
Act
This is action phase of the cycle where we make changes based on what we have learned whether that is repeating what was done, making small modifications, or creating an entirely new plan and cycle. It is the ending as well as the beginning. In this phase, new gaps can be identified, or current gaps can be modified until the goal or objective is met (Nash et al., 2019).
Shaw et al. (2019) utilized rapid cycle PDSA quality improvement model to improve hypothermia in term and near-term infants delivered vaginally. After 4 PDSA cycles, the incidence of hypothermia dropped from 50% to zero at 1 hour of life (Shaw et al., 2019). A similar project utilizing the PDSA would be beneficial in my healthcare organization in the population mentioned above but could be expounded on to include premature infants who are also risk complications secondary to hypothermia. Shaw et al. (2019) found that regular feedback regarding success and correction of the previous PDSA cycles was important to continue to move forward with the quality improvement project. This model is ideal because the cycles required to achieve the necessary change will vary from hospital to hospital and can be affected by many variables but if continued the result will eventually be achieved. The expectation is not that the objective will be achieve after the first cycle, but that continuous improvement will be achieved. Healthcare is a dynamic field where change is the only constant and therefore, we must aim to be improving continuously an not stop the cycle once a goal is achieved.
References
Nash, D. B., Joshi, M. S., Ransom, E. R., & Ransom, S. B. (Eds.). (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press
Shaw, S. C., Devgan, A., Anila, S., Anushree, N., & Debnath, H. (2018). Use of Plan-Do-Study-Act cycles to decrease incidence of neonatal hypothermia in the labor room. Medical Journal Armed Forces India, 74(2), 126–132. https://doi-org.ezp.waldenulibrary.org/10.1016/j.mjafi.2017.05.005
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This is insightful Brittany, there are different quality improvement strategies that can be employed to enhance effective patient outcomes. These approaches/strategies ought to adhere to the organizational objectives and the operational standards. The Plan-Do-Study-Act Cycle is considered one of the best quality improvement model used by different healthcare institutions (Nash et al., 2019). The model involves the application of the systematic processes for gaining valuable learning and knowledge for the continual improvement of the clinical processes, service delivery, and the products used in enhancing the treatment processes (Shaw et al., 2018). This model has been successfully used to facilitate processes undertaken by different healthcare providers. Under this phase of the quality improvement model, we seek to understand the problem and where a gap in practice exists as well as establish an objective laying out what we are trying to accomplish (McNicholas et al., 2019). Through the use of The Plan-Do-Study-Act Cycle, healthcare providers have been able to integrate all the elements required in the treatment processes and to determine the possible outcomes before undertaking the actual quality improvement program.
References
McNicholas, C., Lennox, L., Woodcock, T., Bell, D., & Reed, J. E. (2019). Evolving quality improvement support strategies to improve Plan–Do–Study–Act cycle fidelity: a retrospective mixed-methods study. BMJ quality & safety, 28(5), 356-365. http://dx.doi.org/10.1136/bmjqs-2017-007605
Nash, D. B., Joshi, M. S., Ransom, E. R., & Ransom, S. B. (Eds.). (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press
Shaw, S. C., Devgan, A., Anila, S., Anushree, N., & Debnath, H. (2018). Use of Plan-Do-Study-Act cycles to decrease incidence of neonatal hypothermia in the labor room. Medical Journal Armed Forces India, 74(2), 126–132. https://doi-org.ezp.waldenulibrary.org/10.1016/j.mjafi.2017.05.005
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In addition to the Root Cause Analysis (RCA) model, my colleague can enhance the implementation of the quality improvement process by incorporating a robust educational component. This involves developing targeted training programs and workshops for healthcare professionals involved in the identified adverse events, such as medication errors. The educational component aims to address knowledge gaps, enhance skills, and foster a culture of continuous learning and improvement within the healthcare organization.
To implement this strategy, my colleague can collaborate with educational specialists, clinical educators, and subject matter experts to design tailored training modules. These modules can cover topics such as medication safety protocols, dosage calculations, and best practices in administering medications (Rodziewicz & Hipskind, 2020). The training sessions should be interactive, incorporating case studies and real-life scenarios to engage healthcare professionals actively.
Furthermore, the educational component can extend beyond traditional classroom settings to include online modules and resources, ensuring accessibility for all staff members. Regular updates and refresher courses should be integrated to reinforce learning and keep healthcare professionals informed about the latest evidence-based practices and safety measures.
By incorporating education into the Root Cause Analysis model, this identifies the immediate causes of adverse events and proactively works towards preventing future occurrences (Jones & Despotou, 2016). This strategy fosters a culture of continuous improvement and empowers healthcare professionals with the knowledge and skills needed to provide safer and higher-quality patient care. Additionally, the monitoring and feedback steps of the RCA model can be utilized to assess the effectiveness of the educational initiatives and make necessary adjustments for ongoing improvement.
