Applying Quality Improvement Skills in the Acute Care Setting

Submitter Information

Author: Lynne Bryant, PhD, RN
Title: Assistant Professor
Institution: Radford University
Email: rbryant3@radford.edu

Competency Category(s)
Quality Improvement

Learner Level(s)
Pre-Licensure BSN

Learner Setting(s)
Classroom, Clinical Setting

Strategy Type
General Strategy

Learning Objectives

The student will:

  • Seek information about outcomes of care for populations served in care setting
  • Use tools (such as flow charts, cause-effect diagrams) to make processes of care explicit
  • Use quality measures to understand performance
  • Use tools (such as control charts and run charts) that are helpful for understanding variation
  • Design a small test of change in daily work (using an experiential learning method such as Plan-Do-Study-Act)
  • Practice aligning the aims, measures and changes involved in improving care
  • Use measures to evaluate the effect of change
  • Appreciate how unwanted variation affects care
  • Value measurement and its role in good patient care
  • Seek information about outcomes of care for populations served in care setting
  • Use tools (such as flow charts, cause-effect diagrams) to make processes of care explicit
  • Use quality measures to understand performance

 

Strategy Overview

Students enrolled in a junior level class in Leadership and Management are concurrently enrolled in Adult I or Adult II (acute care medical surgical content and clinical). The content (knowledge, attitude, and skills practice) for the quality improvement projects is covered in the Leadership class, and the data collection part of the project is conducted during the students’ clinical experiences, in collaboration with the clinical faculty. The teacher of the Leadership and Management class facilitates the project and students present the results in that class.

Topics that reflect current issues in health care quality are assigned to each clinical group. Examples of topics include: risk for infection from indwelling urinary catheters, risk for infection from intravenous therapy, risk for inadequate pain management, risk for skin breakdown, risk for
patient falls, and risk for failure to adequately monitor a patient. Students are responsible for working in their clinical groups to identify issues related to the topic during their clinical experiences.

Students examine the issues surrounding their assigned topic while in the clinical setting. They work together in their groups to narrow their projects to a particular process within the assigned topic that can be examined during the time frame of the clinical rotation. Students then flowchart a process related to the assigned topic (for example the process used to identify patients at risk for falls), identify an area of breakdown in that process (for example the distribution of items, such as non-skid slippers, to prevent falls), plan how to measure the breakdown, develop a tool for measurement, and implement the data collection process. After collecting data, they propose a quality improvement strategy based on the analysis of the data.

In previous semesters, students were allowed to use a fishbone diagram as an alternative to a flowchart. Examples of both types of presentations are included in the attached documents.

Week of Class Assignment
Weeks 1 and 2 Introduction to Class and FOCUS-PDCA Process
Week 3 Quality Improvement Topics Assigned
Week 4 Students are instructed to make observations related to assigned topic in clinical setting
Week 5 Students begin to identify and narrow problemStudent flowchart the process within which problem is embedded

Areas of process breakdown are identified

Possible measurement strategies are discussed

Week 6 Students bring draft of data collection instrument to class for review/revision
Week 7 through Week 12 Students collect data in clinical setting; no patient identifying information is connected to any of the data
Week 13 Students conduct data analysis with assistance of instructor as needed
Week 14 Data are reviewed in class and students discuss proposed solution that will be presented in PDCA format
Week 15 FOCUS-PDCA presentation

 

Submitted Materials

Additional Materials

Evaluation Description

The project is evaluated through an oral classroom presentation (see attached project guideline). One of the key issues evaluated is that students demonstrate understanding of data-based decision-making and the relationship between the measurement results and the choice of improvement intervention. Students enjoy the project and have an opportunity to use quality improvement skills actively. Their presentations have been excellent and have even been requested by the managers of clinical units for presentation in the hospital.