HLT-362 Quality Improvement (QI) Proposal Solution

HLT-362 Quality Improvement (QI) Proposal Solution

HLT-362 Quality Improvement (QI) Proposal Solution

Introduction of QI Proposal

Nursing staff, departments, organizations, and the entire health practice encounter numerous problems affecting care quality adversely. In health practice, evidence-based interventions are the standard practice to ensure that solutions are based on scientific evidence. The central focus of this QI proposal is nurse burnout. It is among the prevalent issues in health care organizations affecting nurses’ health and well-being adversely and hampering their ability to provide patient care professionally, promptly, and competently. Nurse burnout is characterized by physical, mental, and emotional drain stemming from demanding workloads, conditions of the work environment, and organizational leadership, among other factors (Shah et al., 2021). Workload, which increased after the outbreak of the COVID-19 pandemic, is among the leading causes of nurse burnout in today’s practice. A recent survey of 50,000 nurses in the United States showed that nurse burnout cause approximately one-third (31.5%) of turnover cases (Shah et al., 2021). As a result, it is crucial to explore the problem, its dynamics in health care settings, and the most effective current solutions. Among many settings, nurse burnout is typical in the emergency department. Unlike other areas, nurses in the emergency department are more susceptible to nurse burnout due to their continuous exposure to traumatic events, COVID-19 pandemic stressors, and varying work schedules (Phillips et al., 2022). The problem intensifies when nurses experience workplace violence, bullying, and other forms of incivility. New graduate nurses are the most vulnerable due to their low resilience, inadequate support, and lack of mentorship. Most cannot cope, particularly when they lack instant and appropriate support. In response, this QI proposal recommends building nurses’ resilience to cope with the increased burnout stemming from the emotional, mental, and physical burden of the COVID-19 pandemic in the emergency department. The purpose of this Quality Improvement Proposal is to determine the effect of mindfulness and resilience training on nurse burnout among nurses in the emergency department.

Although my specialty is cardiac nursing, I often care for patients who are either being admitted for a stroke, or they have a past medical history of a stroke. As you mentioned, time is tissue and every minute counts in these scenarios. Once brain tissue has been without oxygen for too long, there is no reversing that. My facility is stroke certified and we have an average door to CT table time of 10 minutes with our fastest time being 4 minutes. This is something we pride ourselves on since time is so important. According to the Centers for Disease Control, one in four stroke survivors have another stroke within five years (2022). This is why stroke rehabilitation is also of the utmost importance to begin as soon as possible, since some of the lasting effects can be minimized with the proper therapy.

How the QI Proposal Addresses the Problem

Nurses in the emergency department handle complex and critical patient issues. Their health and well-being are essential to providing quality care. Nurse burnout implies a high turnover rate and a lack of consistent patient care. Tavakoli et al. (2018) observed that nurse burnout triggers dissatisfaction since workplace stress and satisfaction are inversely related. Accordingly, a quality improvement initiative is needed to optimize nurses’ health and well-being in the emergency department. Focus areas include building resilience, enabling the nurses to cope, and helping them to have a positive work-life balance. Mindfulness-based stress reduction (MBSR) and resilience training are effective approaches. They are expected to help nurses improve concentration and situational awareness, overcome workplace stressors, and other positive outcomes. The expected outcome is to improve nurses’ health and well-being and their readiness to care for patients visiting the emergency department. Tavakoli et al. (2018) stated that nurse burnout leads to exhaustion, dissatisfaction, lack of concentration, and depression. The quality improvement initiative will prevent nurses in the emergency department from such impacts. Addressing nurse burnout implies high patient engagement since most nurses in the emergency department disengage from their patients due to compassion fatigue. Nurse turnover will also be reduced, reducing the costs of regularly recruiting new nurses.

Research Supporting the Quality Improvement Initiative

Health care and nursing research intensively explore the benefits of mindfulness-based techniques and resilience training in addressing nurse burnout. Most studies depict nurses as vulnerable to burnout, albeit at varying levels depending on the workplace conditions and support. Penque (2019) investigated the impacts of MBSR and found it effective in enabling nurses to cope with workplace stressors. MBSR involves class instruction in mindfulness techniques, yoga, and meditation to promote nurses’ physical and psychological well-being. During the program, nurses learn to embrace their lived experiences, including pain and stress, be open and nonjudgmental, and be present for others. Favorable outcomes include decreased stress and burnout, increased relaxed states, and enhanced situational awareness (Penque, 2019). Professionally trained nurses have a deeper connection with patients and high levels of self-compassion. In a systematic review and meta-analysis of the relationship, Suleiman-Martos et al. (2020) found that mindfulness training reduces nurses’ emotional burden, reducing burnout. In a different study, Slatyer et al. (2018) studied the impacts of a brief mindful self-care and resiliency (MSCR) program on nurse burnout. Among many valuable outcomes, the program helped nurses in a tertiary care hospital to develop feelings of inner calm, gain more perspective and insight, and participate more productively in self-care. Burnout reduced as nurses continued to practice the taught skills.

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Steps to Implement the QI Proposal

The entire process starts with recommending training for nurses in the emergency department experiencing burnout or vulnerable to

HLT-362 Quality Improvement (QI) Proposal Solution
HLT-362 Quality Improvement (QI) Proposal Solution

burnout. As the change agent, the nurse proposing the need for mindfulness and resilience training meets the organization management and stakeholders to rationalize the training as an evidence-based practice project. Stakeholder support is vital since it reduces resistance to change (Jasinska, 2020). An organization’s management prepares its members for change and provides the necessary resources to implement programs with valuable outcomes. After meeting stakeholders and earning the necessary support, nurses should undergo intensive training to enable them to deal effectively with workplace stressors to reduce burnout. Positive outcomes of an MBSR program can be realized in eight weeks (Penque, 2019). Trainers can be internal or external, depending on the availability of the training personnel and resources in the organization.

Evaluating the QI Proposal

Quality improvement initiatives involving training usually consume considerable time and the organization’s resources. Outcome evaluation is necessary to determine whether the project achieved the desired outcomes. The proposed project (mindfulness and resilience training for nurses working in the emergency department) will be evaluated qualitatively and quantitatively. A qualitative evaluation seeks to gain an in-depth understanding of issues, interactions, and observed behaviors (Peters & Fontaine, 2020). It will focus on nurses’ feelings and perceptions of the training and their readiness to implement the taught skills. Focused group discussions and interviews will be used for qualitative evaluation. A quantitative evaluation focuses on numerical figures. It statistically assesses the outcomes of an intervention mathematically using finite data (Peters & Fontaine, 2020). By quantifying outcomes, change leaders can create a factual representation of the outcomes to justify whether the projected outcomes were achieved. Several elements will be used to assess improvement quantitatively. The first element is the percentage change in the reported cases of workplace fatigue/nurse burnout. Reducing burnout is expected to reduce such cases proportionately. The second element is the rate of nurse turnover. A comparative analysis of the turnover before the training and three months after it will reliably indicate whether the project achieved the desired improvement.


Variables, Hypothesis Test, and Statistical Test

Some variables will be used descriptively and others as quantitative elements. Independent variables include mindfulness and resilience training, and nurse burnout is the dependent variable. Regarding the hypothesis test, mindfulness and resilience training will reduce nurse burnout in three months. A comparative analysis of the nurse burnout effects, such as retention/turnover rates and complaints of fatigue before and after the training, will prove or disprove the hypothesis. Statistical tests include calculating the mean and mode of the most reported observations.


Quality improvement should be a priority area in health care organizations and the entire nursing practice. Health care organizations should persistently identify issues that hamper care quality and develop evidence-based interventions to enhance performance. In this paper, nurse burnout has been described as a genuine concern for nurses working in the emergency department. Such nurses are vulnerable to burnout since they work in a high-pressure environment, and their workload has increased since the outbreak of the COVID-19 pandemic. To help them cope with stressors, mindfulness and resilience training can effectively help nurses in critical care areas like the emergency department. Expected outcomes include more resilience, increased coping ability, more engagement in self-care, and a positive work-life balance.


Jasinska, J. (2020). Stakeholders identification affecting the scope and the changes in the health care system. Frontiers1(03), 1-15. DOI: 10.2020/fmcr/000013120

Penque, S. (2019). Mindfulness to promote nurses’ well-being. Nursing Management50(5), 38–44.

Peters, B. G., & Fontaine, G. (Eds.). (2020). Handbook of research methods and applications in comparative policy analysis. Edward Elgar Publishing.

Phillips, K., Knowlton, M., & Riseden, J. (2022). Emergency department nursing burnout and resilience. Advanced Emergency Nursing Journal44(1), 54-62. doi: 10.1097/TME.0000000000000391

Shah, M. K., Gandrakota, N., Cimiotti, J. P., Ghose, N., Moore, M., & Ali, M. K. (2021). Prevalence of and factors associated with nurse burnout in the US. JAMA Network Open4(2), e2036469-e2036469. doi:10.1001/jamanetworkopen.2020.36469

Slatyer, S., Craigie, M., Rees, C., Davis, S., Dolan, T., & Hegney, D. (2018). Nurse experience of participation in a mindfulness-based self-care and resiliency intervention. Mindfulness9(2), 610-617. DOI: 10.1007/s12671-017-0802-2

Suleiman‐Martos, N., Gomez‐Urquiza, J. L., Aguayo‐Estremera, R., Cañadas‐De La Fuente, G. A., De La Fuente‐Solana, E. I., & Albendín‐García, L. (2020). The effect of mindfulness training on burnout syndrome in nursing: a systematic review and meta‐analysis. Journal of Advanced Nursing76(5), 1124-1140.

Tavakoli, N., Shaker, S. H., Soltani, S., Abbasi, M., Amini, M., Tahmasebi, A., & Hosseini Kasnavieh, S. M. (2018). Job burnout, stress, and satisfaction among emergency nursing staff after health system transformation plan in Iran. Emergency (Tehran, Iran)6(1), e41.

Problems in the clinical environment cause significant patient safety and quality challenges. Understanding these issues and addressing them is critical for maintaining a culture of excellence in quality and patient safety. Obstetrics is one of the departments in the health facility that handles a large number of patients. The function of obstetrics is to provide maternal care to women during pregnancy, labor and delivery, and postnatal. A survey of the obstetrics activities reveals there have been recent cases of maternal and stillbirths, or neonatal deaths immediately after delivery that could have been prevented with a more efficient system and highly skilled and supportive obstetrics staff. My trigger to pursue this problem is the concern over high cases of preventable deaths that affect both mothers and infants. I am interested in this as part of global advocacy to eliminate preventable maternal and neonatal deaths, which mostly occur during the labor and delivery window. The purpose of this paper is to present a quality improvement project related to the problem of intrapartum maternal and neonatal deaths.

Organizational Setting

The organization is an acute care facility that handles a wide range of healthcare services. The organization serves the surrounding community, which predominantly consists of low socioeconomic populations. The organization is committed to ensuring quality improvement in all its departments. Moreover, the organization encourages staff autonomy, which creates room for creativity and innovation through the spirit of inquiry. The following are the mission and vision of the organization:

Mission: To provide safe and quality services and be fully responsible for the psychological, physical, social, and spiritual well-being of the community and other populations that we serve.

Vision: To build transformative and innovative healthcare that fosters a culture of quality excellence, safety, and patient-centred care.

The mission and vision all focus on service excellence and commitment to improving the quality and safety of patients. Thus, the QI project aligns with the mission and vision because of the aim to improve the quality of services provided in the obstetric department. This is part of a wider strategic objective to address safety and quality issues at the facility. This QI project will move the organization closer to meeting its mission and vision of transforming healthcare services to ensure quality outcomes and promote the health and well-being of the patients and the entire community served by the hospital.

Problem Statement

The quality improvement project seeks to explore the problem of high rates of intrapartum maternal and neonatal mortality. The problem points to possible issues in the obstetrics process that create the risks of complications. The common complications that occur during the intrapartum process include amniotic fluid embolism, haemorrhage, high blood pressure, and intraamniotic infection (Koutra et al., 2018). Most of the complications during intrapartum are preventable through quality care and early detection. Evidence suggests that proper care, which starts from antenatal contact is likely to lessen the risk of complications during pregnancy and the intrapartum period. Effective antenatal care can enable early identification of complications, leading to proper management to eliminate the possibility of complications during labor (Khanam et al., 2018). Likewise, effective emergency obstetric care also contributes to the reduction in complications during labor, subsequently reducing the risks of preventable maternal and neonatal deaths. On the other hand, inadequate antenatal care and response to obstetric procedures cause complications that can lead to the death of a mother, unborn child, or neonate. This has an immense negative impact on the safety and quality of obstetrics services and the hospital at large.

Evidence Summary

Out of the 13.9 per 1000 births global stillbirth rates, 42·3% are due to intrapartum issues, which are preventable by timely, quality, and responsive obstetrics care (Hug et al., 2021). Further statistics reveal that 300,000 mothers die annually during delivery from preventable causes (Hug et al., 2021). Similarly, a study of deliveries between 2015 and 2020 reported a maternal mortality ratio of 129.34 per 100,000 live births (Sitaula et al., 2021). These mortalities occurred from hemorrhage, sepsis, and hypertensive disorder. Another study showed that out of the 4,476 women investigated, there were 136 stillbirths (Wrammert & Ewald, 2018). Another analysis of obstetric cases between 2012–February 2014 reveals 184 occurrences of near-miss events and 60% of maternal death near-miss events (Rodgers et al., 2018). The near-miss events were caused by hemorrhage at 54.89%, hypertension at 24.45%, and anemia at 13.59% (Rodgers et al., 2018). The common risk factors for stillbirth according to Wrammert and Ewald (2018) are obstetric complications during labor, inadequate antenatal care, hemorrhage, preterm birth, and inadequate monitoring of heart rate. According to Alyahya et al. (2019), proper antenatal care is crucial for the health of the mother and baby throughout the obstetric period including preventing intrapartum complications.

Proper and adequate care extends from antenatal care to care during labor because the effectiveness of the care provided determines the safety of the mother and the child during labor and immediately after delivery. Certain care activities carried out by the obstetrics staff may increase the risk of complications, for example, continuous electro-fetal monitoring, bed rest and restriction of free movement, frequent vaginal checks, limiting oral intake during labor, amniotomy, regional anesthesia, induction, enema, and ineffective pushing (Akyıldız et al., 2021). Another important factor that contributes to the risk of complications is the limited knowledge and expertise of the obstetrics team. Tenaw et al. (2018) note that skilled and knowledgeable obstetrics practitioners who are skilled in the third stage of labor perform proper management of labor and care, reducing the risk of complications.

Intrapartum care is not the only healthcare service affected by complications during labor and delivery, but also postnatal care. According to Wrammert and Ewald (2018) complications encountered during labor increase the risk of having perinatal hypoxia, hemorrhage, and generally, poor postpartum health outcomes for the mother and baby. For example, a study shows that complications during the perinatal period significantly influence postpartum depression in new mothers (Koutra et al., 2018). According to the results, pregnant women who had gestational diabetes and preeclampsia were more likely to have postpartum depression (Koutra et al., 2018). Similarly, hospitalization during pregnancy and unplanned pregnancy were also associated with the odds of postpartum depression. Evidence by Li et al. (2020) reveals similar outcomes that clinical issues during the prenatal and intrapartum period such as complications are more likely to have a psychological impact causing postpartum depression.

Given the evidence on factors that increase the risks of complications during labor and delivery, it is essential that procedures and obstetrics practices are effectively executed to reduce the risk of complications that threaten the life of the mother and baby. According to the World Health Organization (WHO), all healthcare facilities must follow proper guidelines to provide a positive birth experience for mothers. Similarly, the American College of Obstetricians and Gynecologists emphasize the importance of low-intervention approaches during labor period, especially for low-risk women. According to ACOG (2019), using techniques that require minimal interventions during labor has been shown to contribute to high patient satisfaction. As such, gynaecologists and obstetrics teams that support women during labor should avoid practices such as routine amniotomy and continuous electro-fetal monitoring unless there is a concern for a fetal compromise that requires monitoring (ACOG, 2019). Furthermore, instead of high intervention techniques during labor, ACOG (2019) suggests providing a one-to-one emotional, for example, by a doula. Moreover, the staff can provide both non-pharmacological and pharmacological support to cope with labor pain, but avoid restricting movement or position, as well as continuous intravenous fluids infusion. Finally, the obstetrics team should consider family-centric interventions by including the family in the birthing process regardless of the mode of birth (ACOG, 2019).

Current State

Medical technologies in maternity interventions have become part of routine care for women during labor in hospitals including in my organization. These have been shown to significantly improve care and reduce maternal and infant mortality due ability to monitor the fetus in high-risk women and perform life-saving procedures. However, routine use without a valid reason to require the user can quickly transform a positive birth experience from a physiological to a medical emergency requiring surgical intervention. Thus, every intervention during labor presents the possibility of an unexpected turn in events that could endanger both the mother and baby.

Observation and survey of the obstetrics practices during labor indicates that the team provides routine interventions including using technologies such as electro-fetal monitoring without validating the decision for such interventions such as when there is a fetal compromise. This approach as evidence suggests, may be putting low-risk women in danger of complications rather than helping them, thereby increasing the risk of maternal or fetal/neonatal deaths (ACOG, 2019). These practices compromise the principles of patient-centred care and patient autonomy, which are meant to support women to have informed choices in their birth process and promote the natural childbirth process as long as there is no risk of complications. Hence, it is necessary to evaluate the process including the policies and procedures that are guiding the decision-making, conduct, and actions of the obstetric team. Since effective obstetric practices start from the initial contact during prenatal care, antenatal procedures and policies also require scrutiny to identify loopholes that might be exposing pregnant women to the risk of complications.

The intrapartum process initiates when a low-risk pregnant woman due for delivery is cleared for admission after taking the vitals and checking the stage of labor for the nonelective CS. After admission is processed, the next step is to identify whether the woman is in for a vaginal birth or elective CS, for elective CS. For elective CS, the pregnant is prepared for the procedure including skin preparation, monitoring vitals, especially high blood pressure, restriction of food intake, blood and urine tests, administering antiacid, and starting an intravenous line (Akyıldız et al., 2021). A woman who is admitted for vaginal birth is put in bed to rest while frequently monitoring the fetus, checking the mother for dilation, and taking vitals. There is no guideline or procedure in place on how often these should be done. The women are advised to lie on the left side and movement is restricted within the ward. Family members are, however, allowed to provide emotional and moral support.

As the monitoring steps continue, if the obstetrician in charge believes that the patient’s labor may be taking too long to progress, they are put on intravenous fluid and an amniotomy performed. Further, if these fail to produce the desired effect, induction with medication would be considered with the authorization of the gynecologists/obstetrician in charge. Once a woman has fully dilated, they are taken to the delivery room and prepared for the delivery process. The outcome can either be a successful delivery or a complication requiring emergency CS surgery. Most new onset complications occur just before delivery or during delivery. If a woman develops complications, they may have a successful vaginal delivery or stillbirth, or go for surgery which will replicate the possible outcomes. Hence, the possible outcomes regardless of the delivery method are live birth, stillbirth, death of the mother, and neonatal death immediately after birth. Variations are found in the lack of policies or guidelines on how obstetric procedures should be performed.

Root Cause Analysis

The root cause analysis uses the 5Whys. The root cause analysis enables analysis of the systemic issues leading to the root cause of the problem. Without the root cause analysis, the presenting or surface problem may just be a symptom of a larger systemic issue. The 5Whys was a tool developed by The Joint Commission (TJC) to help organizations identify the root cause of problems in their clinical environment. The tool involves asking “why” five times to determine where the problem originates rather than the symptom. In the QI project, the event that occurred is that a patient had a stillbirth and later died after developing complications during the intrapartum procedures. The pattern related to this shows that there have been such cases in the past months involving maternal death, stillbirth or both.

The 5Whys starts with identifying the immediate factor responsible for the cause, which was a complication related to amniotic fluid embolism. The second way shows that the fatal event could have been averted with earlier identification of the underlying complication, but this was not the case. The third why solve why the staff did not identify the issue and not that inadequate staff knowledge and training contributed to this outcome. The fourth why reveals that there are no clear guidelines on the procedures required during labor monitoring and delivery and how to handle unexpected events. The fifth why show that there are no strict/updated policies on routine staff training, obstetrics procedures, and other related issues to support carrying out the procedures and ensuring the safety of patients.

Measurement Plan

The current measurements show that the rate of intrapartum maternal mortality is 30% and neonatal deaths and stillbirths are 27%. The data sets that would be investigated are maternal mortality and infant mortality during and immediately after labor and delivery. The data would be obtained every three from the obstetrics department. The risk officer would be in charge of obtaining the data. Other performances and quality metrics that would be investigated include the rate of intra-amniotic infection, the number of emergency caesarean sections (CS) performed in a month, emergency transfer to labor theatre, obstetrics admission wait time, quality of antenatal care, and patient satisfaction rate. The data would be obtained from incident reports or near-miss reports, electronic health records, a survey of patients and obstetrics team, and admission information.

Gap Analysis

The gap analysis shows that currently, the obstetrics team conduct frequent electro-fetal monitoring during the labor period. However, best practice indicates that electro-fetal monitoring should be minimal and only conducted when the woman is high-risk or has complications causing fetal compromise (ACOG, 2021). For low-risk women, frequent monitoring is unnecessary and may instead put the mother and baby in danger instead of improving health outcomes. The desired state is an obstetric department that records lower emergency CS, less vacuum extraction, and low rates of infections during the intrapartum period. The second issue practised currently frequent vaginal checks. Like electro-fetal monitoring, these too should be minimized according to best practice evidence as they increase the risk of complications.

Similarly, evaluation of antenatal care procedures reveals inadequate follow-up of the pregnant women throughout the pregnancy period to provide psychosocial support and ensure adherence to clinic appointments. Best practice requires that women start antenatal care as soon as pregnancy is confirmed and be supported to remain consistent with appointments (Yeo et al., 2018). The desired state is for patients to receive high-quality and responsive obstetric care from the initial contact during antennal care through to post-natal. The last issue in gap analysis is inadequate staff training to enhance their expertise and knowledge on handling obstetric procedures properly. According to the WHO, best practice in obstetrics care involves frequent highly trained staff, with high competence in obstetrics care (WHO, 2018). The desired state is for patients to have a positive birth experience and satisfaction with obstetrics care.

Project Aims

The following are the QI project aims:

  1. Decrease the percentage of intrapartum maternal mortality of obstetrics patients from 30% to below 10% in the next year.
  2. Decrease the percentage of intrapartum stillbirths of neonates from 27% to less than 7% in the next year.

The key activities that will help in achieving the aims of the project include the use of non-invasive/external methods for fetal monitoring (Liang et al., 2022), availability of adequate equipment and technology for assessing vitals, implementing infection control and prevention guidelines, and conducting effective screening for infections (Blix et al., 2019). Other activities will be the training of staff to become more responsive to patient’s needs, creating a policy and guideline for continuity of care from antenatal, intrapartum to postpartum, and educating pregnant women properly on pregnancy complications and self-care (Ota et al., 2020)


Quality improvement frameworks are roadmaps for a quality improvement project that support effective and efficient implementation. The proposed framework for the QI project is the Plan-Do-Act-Cycle (PDCA). The PDCA cycle provides a constant evaluation and improvement of a project through the identification of challenges and barriers to meeting the project goals. Subsequently, solutions are introduced to address the observed challenges (Chen, 2020). The first stage is planning, which entails planning for changes in the obstetrics department to make the services patient-centred and highly responsive to the needs of the patients who come for labor and delivery. The second phase in PDCA is “Do” denoting activities for implementation or project execution (Pan et al., 2022). The implementation activities for the QI project correspond to the training of obstetric employees, the introduction of guidelines and protocols for obstetrics procedures during intrapartum, education of pregnant mothers during prenatal visits, and equipment update.

The third phase is “Check”, meaning the evaluation of the implemented project to determine how well it is running and whether the objectives are being met. At this stage, the project leader/manager will identify challenges, problems, and risks arising from the implementation of the QI project (Knudsen et al., 2019). The final phase of the cycle is “Act”, which means introducing measures to solve the identified issues in the previous phase. The step ensures that the project continuously runs smoothly by applying solutions to mitigate the risks and challenges that emerge in the course of implementation to keep the project on the course (Qiu & Du, 2021). Furthermore, this last phase of the cycle can act as a standardization step when the goals of the projects are being achieved.


The QI project has been an opportunity to demonstrate key skills and knowledge in QSEN competencies. I have demonstrated improvement and a higher ability not only to understand but also to integrate these competencies in a real practice scenario. For example, my competence in patient-centred care has improved compared to the knowledge and attitude I had in week 1 regarding this QSEN competence. Through this QI exercise, I have gained better knowledge and skills in advocation for patients to promote patient values and choice in services provided. For instance, one sub-objective of the QI is to ensure that patients have a choice of natural birth by ensuring that the obstetrics procedures do not compromise their plans for a natural birthing process. Other competencies that I have improved on include teamwork and collaboration, and evidence-based practice.

I will integrate the competence of evidence-based practice through the skills I have gained in researching and selecting the best evidence. Moreover, as I improve my skills and knowledge in this area, I will appraise sources to determine their quality of evidence and relevance to my QI project. The ability to appraise evidence is critical because not all credible sources are reliable and have the best evidence to support an intervention. Similarly, I will integrate teamwork and collaboration by working with an interdisciplinary team. Interdisciplinary/interprofessional engagement fosters collaboration because of the need to share information and coordinate activities for efficiency and effectiveness. Additionally, teamwork requires setting a goal together that serves the best interests of the patients. Hence, the assessment is an opportunity to work together with the team to set mutual goals and coordinate activities that support excellence in quality and patient safety.



ACOG. (2019). Approaches to Limit Intervention During Labor and Birth. ACOG Committee Opinion, 76.

ACOG. (2021). Approaches to Limit Intervention During Labor and Birth. Committee on Obstetric Practice, 766.

Akyıldız, D., Çoban, A., Gör Uslu, F., & Taşpınar, A. (2021). Effects of Obstetric Interventions During Labor on Birth Process and Newborn Health. Florence Nightingale Journal of Nursing, 29(1):9-21. https://doi.10.5152/FNJN.2021.19093. PMID: 34263219.

Alyahya, M., Khader, Y., & Batieha, A. (2019). The quality of maternal-fetal and newborn care services in Jordan: a qualitative focus group study. BMC Health Service Research, 19, 425.

Blix, E., Maude, R., Hals, E., Kisa, S., Karlsen, E., Nohr, EA., de Jonge, A., Lindgren, H., Downe, S., Reinar, LM., Foureur, M., Pay, ASD., Kaasen, A. (2019). Intermittent auscultation fetal monitoring during labour: A systematic scoping review to identify methods, effects, and accuracy. PLoS One,14(7):e0219573. https://doi.10.1371/journal.pone.0219573.

Chen, Y. (2020). Using the Model for Improvement and Plan-Do-Study-Act to effect SMART change and advance quality. Cancer Cytology, 9-14.

Hug, L., You, D., & Alkema, L. (2021). Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessment. The Lancet,

Khanam, R., Baqui, A., Syed, M., Harrison, M., Begum, N., Quaiyum, A., . . . Ahmed, S. (2018). Projahnmo Study Group in Bangladesh. Can facility delivery reduce the risk of intrapartum complications-related perinatal mortality? Findings from a cohort study. Journal of Global Health, 8(1):010408. https://doi.10.7189/jogh.08.010408.

Knudsen, S.V., Laursen, H.V.B., Johnsen, S.P. (2019). Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects. BMC Health Service Research, 19, 683.

Koutra, K., Vassilaki, M., Georgiou, V., Koutis, A., Bitsios, P., Kogevinas, M., & Chatzi, L. (2018). Pregnancy, perinatal and postpartum complications as determinants of postpartum depression: the Rhea mother-child cohort in Crete, Greece. Epidemiol Psychiatric Science, 27(3), 244-255. https://doi.10.1017/S2045796016001062. .

Li, Q., Yang, S., & Xie, M. (2020). Impact of some social and clinical factors on the development of postpartum depression in Chinese women. BMC Pregnancy Childbirth, 20, 226.

Liang, Y., Li, Y., Huang, C., Li, X., Cai, Q., Peng, J., Fan, S. (2022). Safety of Internal Electronic Fetal Heart Rate Monitoring During Labor. Maternal-Fetal Medicine, 4(2), 121-126. https://doi.10.1097/FM9.0000000000000145

Ota, E., da Silva Lopes K, Middleton P, Flenady V, Wariki WM, Rahman MO, Tobe-Gai R, Mori R. (2020). Antenatal interventions for preventing stillbirth, fetal loss and perinatal death: an overview of Cochrane systematic reviews. Cochrane Database Systematic Reviews. 12(12):CD009599. https://doi.10.1002/14651858.CD009599.pub2.

Pan, N, Luo, YY, Duan, QX. (2022). The Influence of PDCA Cycle Management Mode on the Enthusiasm, Efficiency, and Teamwork Ability of Nurses. Biomedical Research International. 2022:9352735. https://doi.10.1155/2022/9352735.

Qiu, H., & Du, W. (2021). Evaluation of the Effect of PDCA in Hospital Health Management. Journal of Health Engineering, 6778045. https://doi: 10.1155/2021/6778045.

Rodgers, R., DeVries, B., Nassar, N., Beik, N., & Brito, I. (2018). Labour and Obstetric Complications (EP8). International Journal of Obstetrics and Gyneacology, 123(S2), 145-169.

Sitaula, S., Basnet, T., & Agrawal, A. (2021). Prevalence and risk factors for maternal mortality at a tertiary care centre in Eastern Nepal- retrospective cross sectional study. BMC Pregnancy Childbirth , 21, 471.

Tenaw, Z., Yohannes, Z., & Amano, A. (2018). Obstetric care providers’ knowledge, practice and associated factors towards active management of third stage of labor in Sidama Zone, South Ethiopia. BMC Pregnancy Childbirth , 17, 292.

WHO. (2018). WHO recommendations Intrapartum care for a positive childbirth experience. World Health Organization.

Wrammert, J., & Ewald, U. (2018). Incidence of intrapartum stillbirth and associated risk factors in tertiary care setting of Nepal: a case-control study. Reproductive Health, 13, 103.

Yeoh, P. L., Hornetz, K., & Shauki, N. (2018). Evaluating the quality of antenatal care and pregnancy outcomes using content and utilization assessment. International Journal for Quality in Health Care, 30(6),466–471,

One quality improvement opportunity that our organization has identified is in the area of patient data management. In particular, the management have identified ways to improve how employees collect, store, and retrieve patient data. Acme Healthcare System currently contracts with a third-party vendor for the electronic health records (EHR) systems. One of the recommendations from our quality improvement team was to invest in a new EHR system that would better suit the needs of the organization. Another recommendation was to develop a comprehensive patient data governance policy. This policy would set forth how patient data should be collected, stored, and accessed by employees across the organization. The purpose of this assignment is to identify a quality improvement opportunity in my healthcare organization describe the problem or issue and propose a quality improvement initiative based on evidence-based practice.

Overview Of the Problem and The Setting in Which the Problem or Issue Occurs

The problem of patient data management in my healthcare organization is that we have a lot of data, and we not sure what to do with it. The healthcare organization have data from patients’ electronic health records (EHRs), from the billing system, from the laboratory information system, and from other sources. The organization need to find a way to use this data to improve the quality of care given to patients. One idea is to use big-data analytics tools to analyze the data and find patterns that can help us improve approaches for caring for patients. Another idea is to use the data to identify high-risk patients and develop interventions specifically for them. The management is still trying to figure out the best way to use EHR system to enhance patient’s data management.

The problem of patient data management occurs in healthcare settings where accurate and up-to-date patient information is essential for providing quality care. This may include hospitals, clinics, and private practices. The problem arises when there is a lack of communication and coordination between different medical staff members who are responsible for managing different aspects of a patient’s care. This can lead to duplication of records, missed appointments, and even incorrect diagnoses. To solve this problem, healthcare organizations need to put systems in place that allow for better communication and collaboration between all medical staff members involved in a patient’s care.

Why A Quality Improvement Initiative is Needed in This

Area and The Expected Outcome

A quality improvement initiative is needed for patient data management in order to enhance the quality of patient outcomes and to reduce the cost of healthcare. Healthcare providers are collecting more data than ever before on patients, but much of this data is not being used effectively to improve patient care. By improving the way that data is collected, tracked, and analyzed, healthcare providers can make better decisions about how to treat patients and improve their quality of life. In addition, reducing the cost of healthcare will be critical in order to make it affordable for everyone. By improving patient data management, we can reduce waste and ensure that our resources are being used most effectively.

A quality improvement initiative is also needed for patient data management to reduce patient’s data loss. A recent study found that nearly one-third of patients reported they had experienced a loss of health information, largely due to human error. Incidents of lost or corrupted patient data can have significant consequences for both individuals and the healthcare system as a whole. For example, patients may experience delays in receiving care or incorrect treatment as a result of missing medical records. In addition, organizations may face financial penalties and reputational damage when data breaches occur. A quality improvement initiative can help to prevent such incidents by improving the accuracy and consistency of patient data handling processes across all areas of the healthcare system.

How The Results of Previous Research Demonstrate Support for The Quality Improvement Initiative and Its Projected Outcomes

In order to quality assure patient data, health information technicians use a variety of methods which have been found through research to improve the quality of data. The systematic application of these methods is what is referred to as a Quality Improvement Initiative or QI initiative. A recent study (conducted in Canada) set out to determine the effectiveness of a QI initiative on patient data management (Coles et al., 2020). The study found that the introduction of a QI initiative led to an increase in the accuracy and completeness of patient data. Furthermore, it was also found that there was an improvement in other key performance indicators such as turnaround time, staff satisfaction, and patient satisfaction. These findings demonstrate that a QI initiative can lead to significant improvements in data quality.

The results of previous research provide strong support to the Quality Improvement Initiative and its projected outcomes in patient data management. A study by Silver et al. (2017) found that a multifaceted quality improvement intervention was effective in reducing preventable harm events, including readmissions, mortality, lengths of stay, and costs. Moreover, the study also found that the overall quality of care improved following the intervention. This indicates that hospitals which undergo a quality improvement initiative can expect to see tangible improvements in patient safety and outcomes. Such findings underscore the importance of investing in such initiatives and point to the significant potential benefits they offer healthcare organizations.

A recent study published in the journal “Health Affairs” found that the Quality Improvement Initiative (QII) – which is a national effort to improve the quality and safety of healthcare – is projected to result in significant reductions in adverse events, including deaths, hospital readmissions, and costs (Main et al., 2018). The study used computer simulations to estimate the impact of QII on patient data management. The results showed that by 2020, QII could prevent: – Nearly 2 million adverse events, including more than 190,000 deaths, – More than 9 million hospital readmissions, and – More than $150 billion in costs (Main et al., 2018). These outcomes would be achieved through improvements in care coordination and patient engagement.

Steps Necessary to Implement the Quality Improvement Initiative

There are a few key steps necessary for the implementation of an EHR system for the effective management of patient data. First, it is important to consult with experts in the field to get a sense of what system would best fit the needs of your organization. Second, once a system has been selected, it is critical to have a dedicated team to manage its implementation and ensure that all staff are properly trained on how to use it. Third, ongoing communication and feedback from all stakeholders – including patients – is essential to monitor the effectiveness of the EHR system and make necessary adjustments. Finally, it is also important to have a robust back-up plan in place in case of technical difficulties or other issues that may arise. By following these

Discuss steps necessary to implement the quality improvement initiative.



How The Quality Improvement Initiative Will Be Evaluated to

Determine Whether There Was Improvement

When evaluating a quality improvement initiative on the implementation of an EHR system, it is important to collect data around patient management and quality. This can help determine whether there has been an improvement since the EHR system was put in place. The gathered data should be compared against benchmarks or standards to make sure that improvement has actually occurred. Additionally, it is important to get feedback from clinicians who are using the EHR system to see how well it is working for them in their daily workflows. By collecting all of this data and information, the management can create a well-rounded picture of how successful the quality improvement initiative has been.

There are many factors to consider when evaluating the success of an EHR system, but one of the most important is whether or not it leads to improvements in patient data management and quality. When implemented properly, an EHR system can help streamline clinical workflows and make it easier for staff to access and enter accurate patient data. This can ultimately improve patient care by reducing errors and providing more timely and relevant information to clinicians. Additionally, better data management can help support population health initiatives by providing analysts with cleaner and more complete datasets. That said, it is important to keep in mind that improvement in patient data management is just one piece of the puzzle when it comes to assessing EHR success.

The variables to be tested to determine effectiveness of the EHR system include clinical workflows, safety of patient data management, and reduction in errors in the patient data management. The hypothesis tests include: The application of EHR system leads to quality patient outcomes, EHR system leads to the reduction in erroneous patient’s data and leads to effective patient outcomes. The statistical tests needed to prove that the quality improvement initiative has succeeded include student t-test, ANOVA, and Z-test.


Open data initiatives are vital in improving patient data management quality because they allow for interoperability between systems. When stakeholder resource development organizations (healthcare facilities, employer groups, and health plans) standardize on a specific platform or application such as an EHR system, it becomes difficult to manage care coordination. Different forms of electronic patient data platforms used by these organizations compound this problem. One way to improve patient care coordination is to use a system that can connect various types of electronic patient records. Another solution is for developers of EHR software solutions to provide the capability for their systems to exchange information with each other through application programming interfaces or “APIs.”














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 Reviews9(1), 1-22.

Main, E. K., Markow, C., & Gould, J. (2018). Addressing maternal mortality and morbidity in California through public-private partnerships. Health Affairs37(9), 1484-1493.

Silver, S. A., Bell, C. M., Chertow, G. M., Shah, P. S., Shojania, K., Wald, R., & Harel, Z. (2017). Effectiveness of quality improvement strategies for the management of CKD: a meta-analysis. Clinical Journal of the American Society of Nephrology12(10), 1601-1614.