Discussion: Defining and Measuring Quality in Health Care Organizations

Quality is never an accident. It is always the result of intelligent effort.

—John Ruskin

Quality is multidimensional and involves the perspectives of various stakeholders, including patients and families. As noted in this week’s Learning Resources, defining quality is not a simple, straightforward task. Yet, it provides an essential foundation for being able to measure and assess quality, and, ultimately, to improve it.

In this Discussion, you consider definitions and measurements of quality. As you proceed, think about why it is important for organizations to be able to quantify quality and compare current performance to previous performance, to a set of standards, and/or to performance in other organizations. 

To prepare:

Review the information in the Learning Resources, especially the chapters in the Sadeghi, Brazi, Mikhail, and Shabot course text, focusing on how quality is or could be defined and measured.

Think about a health care organization with which you are familiar. It may be the same organization you are focusing on for your Course Project, or a different one. How do you think various stakeholders in this organization would define quality? How would you define quality as it relates to this organization?

Review the information on quality standards and / or aims in the Learning Resources, and consider the following:

Which outcomes related to quality are currently being monitored in the organization that you have selected?

How is related data collected and evaluated?

Does the organization use health information technology in this regard? If so, how?

How is quality-related information (e.g., data, needs for improvement) communicated throughout the organization?

What do you consider to be the strengths and weaknesses of the current approach to quality in this organization?

Post a definition of quality for your selected organization. Describe at least one quality-related measure that is currently being monitored within the organization. Summarize the data collection process for this measure, and explain how this information is communicated to or among the staff. Identify at least one strength and one weakness related to how quality is defined, measured, and/or monitored within the organization.

Read a selection of your colleagues’ responses.

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Compare the organizations’ definitions of quality.

Share an insight about how your colleague’s data and information could be used to formulate a quality initiative.

Suggest additional options for tracking data.

Provide an additional resource to assist a colleague with his or her plan for keeping staff informed and engaged.

Use the below link:

http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementEstablishingMeasures.aspx

Required Readings

Hickey, J. V., & Brosnan, C. A. (2017). Evaluation  of health care quality in for DNPs (2nd  ed.). New York, NY: Springer Publishing Company.

Chapter 6, “Evaluating of Health Care Information Systems and Patient Care Technology” (pp. 143-170)

This chapter examines federally mandated use of health information technology to improve health care and care delivery.

Sadeghi, S., Barzi, A., Mikhail, O., & Shabot, M. (2013). Integrating quality and strategy in health care organizations. Burlington, MA: Jones & Bartlett Learning.

Review Chapter 3, “General Concepts in Quality” (pp. 45–82) (assigned in Week 4)

The authors discuss historical perspectives of quality in various industries, and explain the multifaceted nature of defining quality in health care settings.

Chapter 4, “Current State of Quality Measurement: External Dynamics” (pp. 83–98)

This chapter describes many of the government, nonprofit, and for-profit groups / organizations that contribute to the establishment quality standards and support research to improve the quality of health care.

Chapter 5, “Current State of Quality Measurement: Internal Dynamics” (pp. 99–110)

This chapter focuses on mandatory and voluntary quality measurement in organizations.

Chapter 6, “Measuring Quality of Inpatient Care” (pp. 111–132)

This chapter explains the terminology use in quality measurement (e.g., measures, indicators, metrics), and notes that measurement is a critical foundation for the ultimate aim of creating effective changes to improve quality.

Chapter 8, “Quantifying the Quality Performance Gaps” (pp. 161–177)

This chapter addresses how to quantify current performance and set targets.

Epstein, J. N., Langberg, J. M., Lichtenstein, P. K., Kolb, R. C., & Stark, L. J. (2010). Sustained improvement in pediatricians’ ADHD practice behaviors in the context of a community-based quality improvement initiative. Children’s Health Care, 39(4), 296–311.

Retrieved from the Walden Library databases.

Researchers evaluate a quality improvement project on pediatric care of ADHD patients and the sustainability of the improvement over a two-year period.

Gardner, K., Bailie, R., Si, D., O’Donoghue, L., Kennedy, C., Liddle, H., . . . Beaver, C. (2011). Reorienting primary health care for addressing chronic conditions in remote Australia and the South Pacific: Review of evidence and lessons from an innovative quality improvement process. The Australian Journal of Rural Health, 19(3), 111–117.

Retrieved from the Walden Library databases.

The authors review data from continuous quality improvement projects, and also discuss key features of continuous quality improvement projects and requirements for supporting an initiative on a larger scale.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.

Retrieved from the Walden Library databases.

This report outlines the Institute of Medicine’s (IOM’s) six aims to improve the quality of health care.

Knox, L. M., & Aspy, C. B. (2011). Quality improvement as a tool for translating evidence based interventions into practice: What the youth violence prevention community can learn from healthcare. American Journal of Community Psychology, 48(1-2), 56–64.

Retrieved from the Walden Library databases.

This article discusses evidenced-based practice, how it can be used to not only improve healthcare, but also performance in other fields such as youth and family services.

 Institute for Healthcare Improvement. (2011). Science of improvement: Establishing measures. Retrieved from http://www.ihi.org/knowledge/Pages/HowtoImprove/ScienceofImprovementEstablishingMeasures.aspx

This piece outlines central tenets of measurement for improvement purposes.

 Document: Evidence Matrix (Word document)

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You will do a power point presentation on one of the following topics. 

• Changes that occur with the implementation of a new EHR system—Present the issues such as resistance to change and discuss ways to resolve issues.
• Role of informatics on patient safety and quality
• Assess the impact of information technology on multicultural groups—Discuss and explore how the digital divide impacts different cultural groups. Examine and analyze the factors affecting this issue. Provide recommendations to revolve issues.
• Define data integrity, data management and strategies for maintaining accuracy of data and its impact on healthcare—Define and explore the challenges associated with data integrity and management and the impact on various areas of health care.
• Define and discuss how health care institutions are adhering to HIPAA regulations—Examine this significant issue in nursing and discuss the impact on the profession.
• Analyze the impact if tele-health on the current healthcare system—Define the different types of telehealth. List the pros and cons of each. Give examples of where telehealth might be most useful and issues around access to health care.
• Examine the impact that internet technology has on the security of health-related information—Discuss different ways the Internet impacts health care, for example, WebMD. Discuss and list the pros and cons of each application, website, online journals, or other including accuracy of the information in each one. Discuss security issues of each and provide recommendations to resolve these issues. .

Assignment Instructions:

1. Pick your topic as above and email me for approval. Topics will be first come first serve. 
2. Address this issue through the lens of the nurse informaticist

Your presentation should

• Consist of 15–20 slides in length, including the title and reference slides.
• Use the following bolded topics and subtopics (required) to guide the flow of discussion in your presentation.
• Define and describe the issue. (one to two slides)
  • Describe the background and history of the issue. (two to three slides)
  • Perform a review of the literature. (three to four slides)
  • *Summarize what is known about the issue.
    *Discuss solutions to the issue as identified from the literature.
  • Explain how the issue is being addressed at the organization where each team member is employed. (one slide)
  • Propose a best practice solution integrating information from the review of literature and from team member’s organizations. (one to two slides)
  • Conclusion – one slide
  • Use course content, your textbooks, professional journal articles, and professional websites as references for your work. (A minimum of 10 professional references with at least five (5) nursing journal articles required.)

1. Submit your assignment electronically in the designated location. Sometimes, a voice-over PowerPoint presentation is large and will not submit if the size is larger than the designated drop box. Review the size of your file and check with your instructor regarding any size limits for submission.

Presentation Tips: When submitting a PowerPoint make sure content flows between slides, avoid duplication of information; make sure format, grammar, APA format, and content are seamless and flow. Voice recordings should be done in a quiet environment with easily audible sound levels.

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