Assignment:
Read the article by Larsen et al.: Using Real Time Patient Feedback to Introduce Safety Changes. This article provides a wonderful introduction and example of the rapid cycle change process of Plan Do Study Act. Through the example in the article you can easily see concepts of change theory and quality improvement. Have you experienced this type of process in the environment where you practice nursing?
Larsen, D., Peters, H., &Keast, J. (2011). Using real time patient feedback to introduce safety changes. Nursing Management, 18(6), 27-31.
Read the article by Smetzer et al: Shaping Systems for Better Behavioral Choices. This is a stunning and traumatic example of multiple errors. What has been learned through this experience and what is there still to be learned (in your opinion)?
Smetzer, J., Baker, C., Byrne, F., & Cohen, M. (2010). Shaping systems for better behavioral choices: lessons learned from a fatal medication error. Joint Commission Journal on Quality & Patient Safety, 36(4), 152-163.
View Annie's Story: How a Systems Approach Can Change Culture Safety This video is under 6 minutes long.
Quality Improvement Case Study
Tiffany has worked in the Emergency Department (ED) of a regional medical center for the past year. The average length of stay (LOS) is over 4 hours, the number of patients who leave without being seen (LWBS) has climbed to 180 patients/month, and patient satisfaction scores have fallen to 80%. A Six Sigma team, including ED nurses, ancillary department staff, and physicians, has been established to identify opportunities to decrease average LOS and the number of patients that LWBS. Tiffany, a new member of her department's Practice Council, has been asked to participate. The Six Sigma team will apply the six steps of the QI process to determine an approach to reduce excessive wait times and improve patient satisfaction. The Practice Council completed the first two steps of the process (identify needs most important to the consumer of healthcare service, and assemble an interprofessional team to review identified consumer needs and services) before Tiffany was asked to join.
1. Identify the next step (step 3) in the QI process and an approach the Six Sigma team might take.
2. The Six Sigma Team then moves to the fourth step and identifies the following goals: to decrease average LOS to less than 180 minutes, to reduce the number of patients that LWBS to less than 1% of the monthly volume, and to raise patient satisfaction scores to 97%. What is the next step of the QI process? Identify an effective approach the team might take.
3. Describe the sixth step in the QI process. Speculate on how communication rounds affected wait times, reduced the number of patients who LWBS, and improved patient satisfaction.