Quality Improvement, or QI, is a big thing in the healthcare industry. Healthcare systems always have opportunities to optimize, test, develop, and streamline processes. QI is a continuous process and is done through a QI team.
According to AAFP, quality improvement refers to the systematic and formal approach to analyzing practice performance using various quality assessment tools and using different models to improve performance in healthcare settings. Quality improvement is a proven and effective way to improve the care of patients, clients, and residents and practice for staff.
Quality improvement directly impacts patient safety, satisfaction, and outcomes. It ensures Safe, Timely, Effective, Efficient, Equitable, and Patient-Centered Care (STEEP).
As a nursing student, you will be assigned to write a quality improvement paper or report. If you are not conversant with what to include in your paper, this guide will take you through the step-by-step process of creating a good quality improvement project paper or report. You should not confuse original research with a quality improvement report.
Healthcare sciences, Medical, or nursing students write quality improvement reports or papers to document the problems in their practice areas and develop appropriate interventions, evaluation measures, timelines, and implementation plans to improve healthcare quality. It is a rich document that helps hospital managers to address challenges facing their health organizations by incorporating evidence-based strategies. Both undergraduate and graduate students can write quality improvement projects. When tasked with writing one, follow the steps below:
If you write a quality improvement report or paper based on a case study, skip this step. However, if you are addressing a real-life scenario in a healthcare setting, writing to the management requesting to conduct research for your quality improvement paper is vital.
In most cases, if you have identified a potential practice problem, you must write a proposal on how and why you intend to address the issue.
Suppose you are investigating a problem and need access to pertinent data such as hospital performance records, books of accounting, patient feedback forms, HCHAPS and patient survey results, administrative data, clinical data, SOPs, duty rosters, etc. In that case, you will need clearance with healthcare institutions' top management and leadership teams.
Write a letter to the management explaining your reasons for conducting the quality improvement research and the relevance of engaging their healthcare institution. In addition, you can ask your instructor, preceptor, or nurse educator on the way forward so that you do not land into trouble when you begin writing the report.
With the permission, you then need to move to the next step.
The initial step of a quality improvement project is to map out the specific area that needs improvement. You can identify the area from personal experience of patient care, observation, a critical incident or adverse event, evidence review, patient feedback (complaints, compliments, and discussions), or an audit. Next, you can observe processes and review documentation.
When you have identified an area that needs improvement, the next step is to utilize specific tools to understand the underlying issues.
By implementing evidence-based interventions, you can perform a root course analysis to identify the underlying cause and prevent a recurrence. When looking at the causes, consider the physical, human, and organizational causes.
The physical causes are material items that could fail in one way or the other. Human causes, on the other hand, refer to challenges, mistakes, or failures arising from the healthcare personnel, patients, or those caring for the patients.
Finally, organizational causes refer to the processes, systems, standard operating procedures, or policies that do not function as intended.
Begin by examining the patient population to identify the barriers to care, conditions, or groups of high-risk patients. Next, consider the at-risk patients or patients with chronic conditions and check the problems that might affect them and need QI initiatives.
You should also examine the practice operations. For instance, you can identify the management issues such as high attrition, burnout, low morale, poor patient outcomes, long wait times, poor communication, medical errors, etc.
To do a root cause analysis, you can utilize many tools, including the five whys, drill down, priority matrix, cause and effect diagram (fishbone diagram), driver diagram, Health Failure Modes and Effects Analysis (HFMEA), Sigma's DMAIC model, Failure Modes and Effects Analysis (FMEA) tool, Pareto charts/diagrams, Ishikawa diagram, process mapping, affinity diagrams, and check sheets.
These QI tools should help you identify and prioritize the specific quality improvement problem.
Related Article: Ideas for a capstone change project paper.
Having identified the problem and its underlying causes, it is important to define the project's scope to clarify what you intend to achieve. Your goals should be Specific, Measurable, Achievable, Realistic, and Time-bound (SMART).
You should then develop a multidisciplinary team to facilitate the project. First, consider the stakeholders, such as healthcare professionals, the management team, patients, patient representatives, and government representatives.
Coming up with the goals and the project team helps shape the project ideas and is a positive indicator of the need for improvement. Next, consider engaging all the stakeholders and solving any issues leading to resistance.
To successfully evaluate the progress or effectiveness of a quality improvement intervention, it is imperative to measure the change. You should, therefore, take measurements to demonstrate the success or failure of the project.
Before implementing any changes, have a baseline measurement to track the project's progress. Your baseline should have at least 15 data points so that you can analyze the changes through time.
Consider all the healthcare quality measures, such as structural, process, balancing, and outcome measures, to identify the areas that need improvement.
Look at the patient medical records, patient surveys, patient comments, feedback from social media pages, standardized clinical data, and administrative data to prioritize the quality issues or problems in a healthcare setting.
Prioritize the problems based on their urgency to the specific organization and choose one that needs to be addressed immediately for your paper. You can also create a questionnaire to measure the baseline data.
With the data collection results and comprehensive analysis of the baseline data, you need to develop interventions to address the issue.
Here is where you also choose the most appropriate QI model. Some of the quality improvement models include PDSA, Six SIGMA, Model for Improvement (MFI), ISBAR, Rapid Cycle Intervention (RCI), Experience-based Co-design (EBCD), FADE model, six sigma DMADV model (define, measure, analyze, design, verify), business process reengineering, total quality management (TQM), and the lean model.
It is important to note that planning and implementing the intervention (s) needs to be done through small-scale changes. Piloting the interventions on a smaller scale than a single extensive intervention addresses the challenges with resources. Effectively, most QI models entail aspects of the plan, do, study, act (PDSA) cycle.
So you need to plan the intervention, implement it and collect the data, analyze the collected data and compare them to predictions, reflect on the lessons learned, and plan the next cycle of change or go into full implementation. So be very meticulous when planning the intervention.
You must then develop a strategic map or plan to help you implement the change at the full scope. Include the timeline for implementing different aspects of the QI project, the responsible teams, evaluation measures, the process of monitoring and evaluation, and how to ensure that everything progresses well.
Detail how you will sustain the changes you have achieved so far. Therefore, after implementing the small changes and making the necessary adjustments, you must schedule the full implementation of the intervention. Consequently, it is crucial to anticipate the success factors and some of the challenges that might affect the performance of the QI project.
You should document how to incorporate the changes into standardized frameworks to sustain them. For example, common frameworks could include proformas, checklists, protocols, SOPs, hospital policies, and guidelines. You can also incorporate the project into the hospital QI database for sustainability.
After concluding your project, you need to do a QI project report or write-up to disseminate the findings. You can develop flyers, presentations, reports, or blog posts to share your results with your peers and the senior hospital management. Doing a QI report can also be handy as it will reach a wider audience once published online. You can also share your project during grand rounds or QI project symposia so that people learn new ways to address certain aspects of healthcare. Also, include it in your online portfolio or blog to boost your resume. If your interventions yielded significant results, consider writing up the project as a journal article or abstract presentation.
In the next section of this guide, we take you through the necessary parts of a QI project report.
There is no prescribed format for writing up a QI project report. However, you should ensure that it is professionally written. This means writing it using formatting styles such as AMA, APA, or Harvard. In addition, you can follow the SQUIRE guidelines when developing the report. In the many years we have helped nursing and med students write QI project reports, we have followed the structure below, and all the projects have been successful.
Type the title of the paper. It should be around 50 words and indicate the area of improvement you are focusing on.
The abstract is the summary of your work, attracting your readers' attention. Ensure that you offer a brief background of the problem, the method for your quality improvement project, the QI models and tools used, the timelines, results, and the conclusion.
An abstract is about 200-300 words. It should be factual, succinct, and refined. If you are writing in APA or Harvard, do not indent the abstract.
The introduction should describe the importance and relevance of the QI problem beyond your current station of practice (hospital, clinic, nursing home, or community health center).
You should also state the gap between what is currently known and done and what needs to be done or known to achieve the desired quality improvement outcomes. You should also provide the context of the project, which entails describing the healthcare setting and the relevance of the problem.
You should give a brief overview of the problem, the proposed intervention strategies, the steps, and the timeline for intervention.
Your introduction also includes the measures you used to prioritize the problem and the evaluation measures for the interventions.
In the introduction, you also introduce the quality improvement teams you worked with when implementing and assessing the effectiveness of the interventions.
Under the methodology section, you should focus on the measurement, design, and strategy.
Measurement section deals with explaining the measures you selected to study the processes and outcomes of the intervention.
You should describe the rationale for choosing the measures and their definition and comment on their reliability and validity.
Describe how you planned to collect the data through the project and how frequently the data was collected. You should also outline how you planned to establish if the observed outcomes were due to the implemented interventions.
Under the design sub-topic, describe the intervention (s) you implemented to improve the quality of care in your healthcare setting. Describe any assumptions and rationale for developing the interventions. If you used QI tools, ensure to mention them.
Also, mention the QI models that guided the implementation of the interventions. Finally, introduce the project team and elaborate on how you engaged or consulted with the team members or the entire organization.
If there were any barriers, mention them, including how you overcame them. You should also report the report's timeline, detailing every step taken and when it was taken. Also, describe how you planned to make the intervention sustainable.
Finally, you need to explain the strategy for improvement, demonstrating how you implemented your improvement cycles. Then, focus on the interventions and improvement cycles that worked.
If there are any hurdles, mention them. Then, describe the progressive improvement cycles, lessons learned, how such learning influenced change, and if the change predictions were needed to influence the outcomes.
The results section should be a paragraph or a few paragraphs that summarize the essential findings from the implementation.
You should provide a summary of the results. If there are visuals such as tables or charts, explain what they mean. Describe any variation in your data to elaborate on whether or not the interventions worked. You should also describe the contextual elements that interacted with the interventions and how they might have influenced the results.
You should briefly compare the results to the baseline measurements you took before the QI project. Also, comment on how you assessed the data's completeness, validity, and accuracy.
You should also comment on whether there were unintended consequences such as unexpected delays, failures, problems, or costs associated with the interventions.
Share with your readers the ongoing findings after implementing the interventions. Is there a positive or negative change? Are your objectives being met? What areas need to be tweaked or changed? Are there any challenges?
Reflect on the implications of the results on the setting. If any lessons are learned, especially those that impact the result, include them in this section.
As well as reflect on the limitations to the implementation of the project. Describe any biases and confounding factors that could have affected the results and your efforts to adjust to the limitations.
Also, discuss the limitations of the chosen models or steps and how they could have affected the findings. Also, briefly mention and explain the potential future recommendations or actions to make it work well.
It could be that the time was limited or there was resistance from the workforce. Let the readers understand why things never went as they were predicted.
You can use subheadings to organize this section.
The conclusion reflects on the project's background, noting what is known on the topic and the new knowledge that your project brings forth.
This is never a chance to introduce any new concepts. If your project had goals, ensure that you state how they were met or if you adjusted the scope of the aims as you proceeded.
Explain if the measures were appropriate and if there were any balancing measures used in your project. You can describe the cost analysis and demonstrate the effectiveness of the intervention.
Report on the sustainability of the intervention based on the data. If the intervention can be generalized, give recommendations that can be used to make it a success in different settings. Also, mention any steps you would recommend for further study so that the limitations of the current QI project are overcome.
Organize your references alphabetically in APA, AMA, or Harvard format. Ensure that you only include the sources that are referenced within your report.
Include supplementary materials such as graphs, flow charts, diagrams, and relevant images in the report.
If you are at the writing stage, here are some considerations.
Consider these ideas and topic areas if you plan to undertake a quality improvement project.
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