Assessment Title Assignment Task Description Using the patient safety or quality of care indicator you examined in assignment 2, develop a comprehensive plan for improving care related to that indicator within a nominated health care setting. Your plan should include an analysis of the issues that contribute to the patient safety or quality of care indicator in the nominated setting. This should also include evidence of the patient experience and any literature available on the experiences of patients related to your chosen indicator. Please ensure that your clinical reasoning for making decisions about the indicator and the causes associated with it is evident within your analysis. These decisions should be supported by research evidence and must be clearly described. A Fishbone diagram and / or use of the London Protocol may be used to support your decision making. Once you have established the causes associated with the indicator, develop a plan for improving care related to the indicator in your nominated setting. Use a series of Plan-Do-Study-Act cycles (a maximum of 3 small change cycles) to describe the changes you would initiate. Outline what you would do in each of the Plan-Do-Study-Act cycles to test the changes implemented in each cycle. Explore your role and the role of health care leaders in improving care related to your chosen indicator. Assessment Due Date 27th May 2017 (Week 11) by 23:55 hours Return Date to Students Release of results Length 2500 words Weighting 50% Assessment Criteria Your assignment will be evaluated on the following assessment criteria: Knowledge & understanding – 50% Relevance to practice – 20% Structure, Organisation & Presentation – 30% Referencing Style Author – Date (Harvard) A summary of the Harvard system can be accessed in the online guide on the Library website at: Submission Your assignment will be submitted into a Turnitin submission box within the SNPG927 Moodle site. You will have the opportunity to review and re-submit your assignment up to the due date and time. Subject Learning Outcomes Assessed Explore and critically analyse current literature regarding health service design and delivery. Analyse client/patient narratives and ‘nursing stories’ about care and caring. Synthesise literature relating to current models of clinical supervision within a selected nursing workplace Explore principles of risk assessment, surveillance and monitoring; Analyse the concept of clinical reasoning in the context of clinical excellence. Demonstrate your understanding of clinical reasoning, risk assessment and surveillance to develop a plan for improving a quality or safety indicator within a workplace setting In my first assignment I have chosen pressure ulcer as quality indicator… Topic 1: Clinical Excellence Some background information .... The definition of clinical excellence in nursing has not yet been established. Part of the reason for this is that nursing is conceptualised and practiced differently by individuals. Many nurses hold different views on what nursing care is and how it should be delivered. There are some commonalities in these views but there are also many differences and a high degree of subjectivity. Nurse's views on clinical excellence are influenced by the individual nurses’ philosophical approach to nursing, their education and background, their nursing experiences and the practice settings in which they work. Research on what constitutes a good nurse has been undertaken. From a nurses’ perspective the following four characteristics have been identified (Arman & Rehnsfeldt 2007; Bassett 2002; Lynn & McMillen 1999; Miller 2006; Smith & Godfrey 2002): - personal characteristics (caring, being present, showing compassion, showing respect for self and others); - professional characteristics (being patient-centred, respecting the code of ethics and professional standards of care); - knowledge base (forming a strong professional and situational knowledge base, using critical thinking); and - professional skills (demonstrating safe and competent nursing care). Patients, in contrast have differing views on what good quality nursing involves. They are likely to care more about the communication, listening, kindness and responsiveness of the nurses that are caring for them (Burhans & Alligood 2010). American journalist and advocate for nursing, Suzanne Gordon (2006, p.2, 4), offers this summary of nursing: Using their considerable knowledge, [nurses] protect patients from the risks and consequences of illness, disability, and infirmity, as well as from the risks and consequences of the treatment of illness. They also protect patients from the risks that occur when illness and vulnerability make it difficult, impossible, or even lethal for patients to perform the activities of daily living - ordinary acts like breathing, turning, going to the toilet, coughing, or swallowing... Nurses, regular, ordinary, bedside nurses, not just nurse practitioners or advanced-practice nurses, are constantly participating in the act of... diagnosis, prescription, and treatment and thus make a real difference in ...outcomes. Action: Think about your views on clinical excellence, patient safety & quality of care. Any thinking you do on this topic will be the beginnings for assessment task 1. Australian Safety & Quality Framework for Health Care The Australian Commission on Safety & Quality in Health Care (ACSQHC) developed and endorsed a framework for safe, high quality health care in 2010. The framework describes three central tenets to ensure that health care is safe and of high quality. They state that safe, high quality care is always: Consumer-centred Driven by information Organised for safety Access the resources at this website to explore resources about this framework and the work of the ACSQHC http://www.safetyandquality.gov.au/national-priorities/australian-safety-and-quality-framework-for-health-care/ World Health Organisation The World Health Organisation (WHO) launched a Patient Safety program in 2004. Their program focuses on patient safety and has as it's vision: Every patient receives safe health care, every time, everywhere (WHO 2004). Please access the World Health Organisation webpage for patient safety to explore some of their programs and goalsQSEN Competencies The QSEN competencies are six core competencies from the Quality & Safety Education for Nurses project funded by the Robert Wood Johnson Foundation in the United States. Please read: Sherwood, G & Zomorodi, M 2014, ‘A new mindset for quality and safety: The QSEN competencies redefine Nurses’ roles in practice’, Nephrology Nurses Journal, vol. 41, no. 1, pp. 15-23,72. The competencies have been developed to educate undergraduate nurses and inform practicing nurses about the knolwedge, skills and attitudes that are required to improve the quality and the safety of nursing care. The Six competencies are explored in the table below which has been reproduced from Sherwood & Zomorody (2014, p. 18). http://www.who.int/patientsafety/about/en/ Topic 3: Quality of care indicators Pre-reading There is some pre-reading for this topic. Please read: Burhans, LM & Alligood, MR 2010, ‘Quality nursing care in the words of nurses’, Journal of Advanced Nursing, vol. 66, no. 8, pp. 1689-1697. Gillam, S & Siriwardena, AN 2013, ‘Frameworks for improvement; clinical audit, the plan-do-study-act cycle and significant event audit’, Quality in Primary care, vol. 21, pp. 123-130. Johnson, J 2012, 'Quality Improvement' in G Sherwood & J Barnsteiner (eds), Quality and safety in nursing: A competency approach to improving outcomes, Wiley-Blackwell, Chichester, pp. 113-132. Quality of care indicators In the questionnaire at the beginning of this topic you were asked to identify some of the potential indicators of quality. This page will continue to explore this concept. Some of the most common quality of care indicators discussed in practice and explored in the literature are: Patient satisfaction with care Effectiveness of care (often used to examine implementation of evidence based practice and usually disease specific) Presence of caring attitudes / actions Person-centred approaches to care delivery ACTION: Have a think about these indicators of quality of care. How often do you collect or discuss quality of care indicators? What other indicators of quality care should we collect? Should we ask our patients if they have experienced high quality care? Donabedian's framework for quality Avedis Donabedian published his seminal work on measuring the quality of healthcare in 1966. He described three categories for measuring the quality of care (Donabedian 1980). The three categories are structure, process and outcomes. Structure relates to the attributes of the settings in which the care occurred (Donabedian 1988). It includes the characteristics of the organisation, the physical setting and characteristics of the staff. Process relates to what actually occurred in giving and receiving care (Donabedian 1988). It includes the actions of the patient or client as well as the actions of the healthcare team members in delivering care. Outcomes relates to the changes that are observed in a patient or client’s health condition that result from the care that has been provided to them (Donabedian 1988). It thus includes changes in patient knowledge, self-care ability, the relief or management of symptoms, changes in health condition and patient satisfaction with care. Donabedian (1988, p. 1745) states that “this three-part approach to quality assessment is possible only because good structure increases the likelihood of good process, and good process increases the likelihood of a good outcome.” This framework is used in a large percentage of evaluation of health care services. Plan-Do-Study-Act cycles The Plan-Do-Study-Act (PDSA) cycle is a commonly used tool to test a new idea or solve a problem. The PDSA cycle involves repeated, rapid, small-scale tests of change (Gillam & Siriwardena 2013). It can be used to test incremental change or used to evaluate different approaches. The following stages are involved: First develop a plan and define the objective (Plan) Second, carry out the plan and collect data (Do), then analyse the data and summarise what was learned (Study) Third, plan the next cycle with the necessary modifications (Act). https://www.youtube.com/watch?v=8Q7qnNpTWxM Fishbone diagrams Fishbone (or Cause & Effect) diagrams are another commonly used tool to investigate the cause of problems. Watch this video on Fishbone diagrams https://www.youtube.com/watch?v=Fwfgx0dOYvE Topic 6: Workplace Culture Pre-reading There is some pre-reading for this topic. Please read: Disch, J 2012, 'Leadership to Create Change' in G Sherwood & J Barnsteiner (eds), Quality and safety in nursing: A competency approach to improving outcomes, Wiley-Blackwell, Chichester, pp. 289-303. Triolo, PK 2012, 'Creating Cultures of Excellence: Transforming Organizations', in G Sherwood & J Barnsteiner (eds), Quality and safety in nursing: A competency approach to improving outcomes, Wiley-Blackwell, Chichester, pp. 305-321. Chaboyer, W, Chamberlain, D, Hewson-Conroy, K, Grealy, B, Elderkin, T, Brittin, M, McCutcheon, C, Longbottom, P & Thalib, L 2013, ‘Safety culture in Australian Intensive Care Units: Establishing a baseline for quality improvement’, American Journal of Critical Care, vol. 22, no. 2, pp. 93-102. What is workplace culture? Given that the fundamental unit of every workplace is people .... then the way people talk to each other, treat each other, the way individuals support each other and how this looks to each other and outsiders can be considered the workplace culture. Every workplace has its own overarching culture but it also has many sub-cultures. Each culture is integrated by a set of values, attitudes, beliefs, social and professional norms, systems and structures (Triolo 2012). This is why sometimes you can be at work with one set of people and it "feels" one way and then on another day it "feels" really different (sometimes the same people are present on both days and other times it is a completely different set of people). If we want to promote clinical excellence then safety and quality must be embedded into the culture as values to create a culture of safe, high quality care. If we ignore culture then most attempts at improving care or improving practices tend to be unsuccessful. Creating Caring Cultures Please watch this video to explore how we can create caring cultures within healthcare. https://www.youtube.com/watch?v=cZyN_UZvYnQ Topic 2: Patient Safety What is a safety culture? Please review this short video that you watched in Topic 2: https://www.youtube.com/watch?v=DBVuu4Qj-Fs One of the most important concepts to understand is that in a culture of safety the focus is on effective teamwork to accomplish the goals of safe, high quality patient care (Barnsteiner 2012) Within a culture of safety, when an adverse event or error occurs, the focus is on what went wrong, not who is to blame (Barnsteiner 2012). ACTION: If you didn't already do this in Topic 2 then, please access the appropriate form for your type of workplace, print it and then complete it. This will provide you with a snapshot of the patient safety culture in your workplace. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/index.html What is your role in the culture of your workplace? Spend some time thinking about your role in your workplace and the culture of that workplace. You might want to consider making a mind map to document your thoughts on. There are lots of great tools available to support doing this so if you already have a preferred way then use that. If not, here is a link to www.biggerplate.com It has lots of resources, templates and suggestions that you might want to explore. http://www.biggerplate.com/ What actions can you take to lead change related to workplace culture? Every person in every workplace has an impact on the workplace culture. This is true, even when it doesn't always feel like this is the case. Just by being in and contributing to a workplace you also have a role in the workplace culture. If we think about the definition of culture as ..... "the way things are done around here" ..... then you can recognise that we all have a role to play. Topic 7: Person-Centredness Pre-reading There is some pre-reading for this topic. Please read: Walton,MK & Barnsteiner, J 2012, 'Patient-Centered Care' in G Sherwood & J Barnsteiner (eds), Quality and safety in nursing: A competency approach to improving outcomes, Wiley-Blackwell, Chichester, pp. 67-89. Please review the resource available at this link. It has been developed by the Foundation of Nursing Studies (FoNS) in 2015. https://www.fons.org/learning-zone/culture-change-resources.aspx Topic 5: Teamwork & Collaboration Pre-reading There is some pre-reading for this topic. Please read: Disch, J 2012, 'Teamwork and Collaboration' in G Sherwood & J Barnsteiner (eds), Quality and safety in nursing: A competency approach to improving outcomes, Wiley-Blackwell, Chichester, pp. 91-112. Perry, B 2009, ‘Role modelling excellence in clinical nursing practice’, Nurse Education in Practice, vol. 9, pp. 36-44. Teamwork in Healthcare We have all been involved in education about teamwork and we all know that to work in healthcare we must be able to work in teams. ACTION: Take some time to think about your role in teams. How do the teams you are involved in communicate with each other? What do you have in common? Do you have shared goals? How do you know when you achieve your aims? What does it feel like to be part of that team? What could be done to improve the functioning of that team? Watch this video about teamwork in healthcare, to help you to explore these issues ... https://www.youtube.com/watch?v=tayu95atBP0 Topic 4: The Human Factors Pre-reading There is some pre-reading for this topic. Please read: Levett-Jones, T, Hoffman, K, Dempsey, J, Yeun-Sim Jeong, S, Noble, D, Norton, CA, Roche, J & Hickey, N 2010, ‘The “five rights” of clinical reasoning: An educational model to enhance nursing students’ ability to identify and manage clinically “at risk” patients’, Nurse Education Today, vol. 30, pp. 515-520. Human Factors overview This video provides an overview of Human Factors Please watch this video on Human Factors https://www.youtube.com/watch?v=Hm7k0TRaPHI