Outcome Measures and Performance Issues Report

Introduction

A primary aim of a health facility is providing the quality and safe care to patients. This objective can only be achieved if the various departments of a health facility can seamlessly coordinate their activities and dedicate themselves in carrying out these activities in accordance to the internationally recognized standards of practice (Huffstutler & Thomsen, 2015). This paper intends to provide a report that will describe the current quality and safety outcomes in the hospital. It will then describe how specific organizations functions, policies, processes, procedures, norms, and behaviors can be used to improve the hospitals quality and safety outcomes. Finally, the paper will provide a strategy which can be used to improve the quality and safety outcomes in the hospital.

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In the previous executive assessment, several issues regarding quality and safety outcomes were identified. Understaffing was the major issue which played a significant role in adversely affecting the quality and safety outcomes for patients in the hospital. Understaffing was blamed for the high number of patients who were denied admission in the hospital. Lack of follow-up on patients who had been admitted in the hospital and delayed attendance to patients were also attributed to understaffing. Even patient safety is put at risk because the few nurses and healthcare workers who are available have to hurriedly attend to patients for them to provide care to as many patients as possible.

Understaffing was directly linked to a weak human resources department and a non-committal finance department. The human resource department failed to determine the appropriate number of healthcare workers needed at the facility while the finance department did not provide enough funds for staff welfare. We can, therefore, say that, if these two departments performed their roles adequately, probably the hospital would have performed better regarding quality and safety of care delivered to patients.

Research has shown that there is a positive relationship between staffing levels and quality and safety of care provided to patients. According to Montalvo (2017), hospitals with higher staffing levels had lower patient falls as compared to those with low staffing levels. Another research on quality of care determined that the skill of the nurses also determined the quality of care that the patients received (The Joint Commission, n.d). An example is given of an hospital which reduced the rate of hospital-acquired pressure ulcer by over fifty percent as a result of assigning specialists in wound/ostomy/continence to specific nursing units (Montalvo, 2017). Therefore, we can say that a hospital needs the right amount of staff who have the correct mix of skill for it to provide safe and quality healthcare to patients.

Having the right staff who have the correct mix of skills and experience is not enough in delivering safe and quality care. A culture of nursing excellence should also be cultivated among the staff (Fessele, Yendre & Mallory, 2014). This will ensure that the nurses have an internal desire and purpose that drives them to give their level best when attending to patients. For the culture to be adopted in a hospital, the nurse leader should play a pro-active role in engaging front-line staff and making them appreciate the hospital's vision (The Joint Commission, n.d). The nurse leader should also ensure that the front-line nurses understand and adopt cultural values that promote safety and quality outcomes. It has been proven that front-line staff who feel that their suggestions and contributions are respected and their good work given recognition are more likely to provide quality and safe care than those who do not (Huffstutler & Thomsen, 2015).

Hospitals that are high-performing when it comes to quality and safety are known for their relationship-building strategy (Huffstutler &Thomsen, 2015). They build these relationships through systematic engagement with employees, health care providers, customers and the community around them. It is through these engagements and getting feedback from their stakeholders that they can get useful and relevant data. This data is then used to identify areas where the hospital is required to improve for it to perform as expected.

High-performing hospitals are also known to have cultures that are value-driven. Huffstutler & Thomsen, (2015) notes that the mission, vision, and values of these hospitals "are not just words written and posted on walls, these noble words live in every member of staff in the hospital." Some of the institutions known for their value-driven culture go the extent of screening their employees before employment to ensure that they only hire people whose values correspond with those of the institution (Huffstutler & Thomsen, 2015). To further inculcate a culture of values, some of the high performing institutions take time to teach their staff the importance of living according to the hospital's values. Staff who perform well in upholding these values and in living according to its mission are even awarded to motivate others to follow suit. These hospitals are therefore able to provide quality and safe care to their customers because their staff execute their duties by the hospital's values.

Proper execution of the strategic plans and goals plays a role in determining the quality and safety outcome of a hospital. High performing hospitals first ensured that their strategies were aligned to their mission, vision, and values. Alignment ensures that the strategies that the hospital intends to pursue are not only achievable but easily adoptable by members of staff (Fessele, Yendre & Mallory, 2014). These hospitals also have accountability systems in place to promote transparency in the manner in which the goals and objectives of the hospital are achieved (Goll & Cahil, 2014). The high-performing hospitals have also adopted simple tools that are designed to help members execute their work. These tools are helpful in guiding the staff towards achieving the desired level of quality and safety outcomes (Goll & Cahil, 2014). Their application has enabled the hospitals to manage and improve their process and as a result, achieved higher results in outcome measures.

Financial stability is also another factor that is key in improving quality and safety outcomes. A hospital that is financially secure can fund all the factors that are required to improve quality and safety outcomes including staff employment and welfare (Fessele, Yendre & Mallory, 2014). High performing hospitals improved their financial stability through increasing their annual operation margins and debt-service coverage ratio (Goll & Cahil, 2014). These hospitals also ensured that their employees were empowered through helping them deal with stress and fatigue, recognizing their excellent work and also respecting their contributions and opinions (Goll & Cahil, 2014).

Finally, high performing hospitals dedicated their resources in ensuring that patients were provided with the highest quality of care. Some of the efforts initiated by the hospitals in a bid to increase quality of care include partnering with other hospitals to reduce the "door-to-balloon" time for heart attack patients to less than forty-five minutes (Huffstutler & Thomsen, 2015). This has ensured that no patient loses their life as a result of a heart attack. The hospitals have also reduced readmission rates through ensuring that patients who have chronic diseases continue having access to care even after they are discharged, providing a complimentary visit to patients when requested and also conducting follow-ups on patients to ascertain their health condition even after they leave the hospital (Huffstutler & Thomsen, 2015).

Lippit's Change theory can be used to develop a strategy that can be used to promote and sustain a culture of quality and safety. The theory has seven stages namely: problem diagnosis, motivation assessment, assessment of change agent's motivation and resources, selection of objectives for progressive change, determining the role of the change agent, maintenance of change and finally termination of the helping relationships (Mitchell, 2013).

The first step in promoting quality and safety outcomes in patient care is in diagnosing the problem. The health facility had several problems which had already been diagnosed. These problems included: turning away of patients, lack of follow-up on medical conditions of patients and handling of patients in a hurried manner. The assessment of motivation step then follows this step. The nurse leader conducts an assessment of the problem that is adversely affecting quality and safety outcomes for patient to determine its cause (Mitchell, 2013). For our health facility's case, lack of enough staff is the cause if all the problems that pertain to quality and safety outcomes of patients. After determining the cause of the problem, the lead nurse can then brainstorm with other hospital leaders on the best way to solve the nursing shortage in the health facility.

The next step in implementing the desired change is the hiring of a change agent who will champion the change process. The nurse leader's role in this stage is ensuring that the change agent can deliver the desired change (Mitchell, 2013). For a change agent to be effective in his work, he should have the "stamina, experience in initiating change" (Michell, 2013). He should also be accepted by the nurses and the staff at the hospital. Once the change agent has been identified, the nurse leader together with the change agent will then engage the health facility's executive members, and junior staff in coming up with timetables and deadlines for achieving the desired outcomes (Mitchell, 2013). All parties are then assigned responsibilities which they are expected to fulfill. The change agent's duties and responsibilities are then defined to ensure no misunderstanding or resentment occurs (Mitchell, 2013). Some of the duties which the change agent is expected to carry out include coaching and training employees with the necessary skills required for them to implement and sustain the change.

Conclusion

Once the change has been introduced and implemented, maintaining the change will be the next step. At this stage, the nurse leader monitors the progress made so far. She then calls all parties that are playing an active role in the change and encourages them to communicate with each other. Communication provides the staff with an opportunity to share their challenges and create an opportunity for them to look for ways to better solve these challenges (Michell, 2013). Recognizing staff who did an exemplary work during the change is also recommended at this stage as it will keep the employees motivated and determined to effect the change (Michell, 2013). Finally, terminating the helping relationship becomes necessary once the change has been engrained in the health facility's culture. This step should be implemented gradually for a smooth transition to take place.

References

Goll, C., & Cahill, S. (2014). Enculturating the value of process improvement - American Nurse Today. Retrieved from https://www.americannursetoday.com/enculturating-value-process-improvement/

Fessele, K., Yendro, S., & Mallory, G. (2014). Retrieved from https://cjon.ons.org/file/8246/download

Huffstutler, C., & Thomsen, D. (2015). A Framework for Performance Excellence and Success. Retrieved from https://www.questia.com/library/journal/1P3-3819981151/a-framework-for-performance-excellence-and-success

Michell, G. (2014). Selecting the best theory to implement planned change. Retrieved from http://home.nwciowa.edu/publicdownload/Nursing%20Department/NUR3...