Author: Elizabeth Murray, PhD, RN, CNE
Title: Assistant Professor
Institution: Florida Gulf Coast University School of Nursing
Quality Improvement, Safety, Teamwork and Collaboration
Classroom, Clinical Setting
Upon completion of this activity, students will:
1. Examine how the safety, quality, and cost-effectiveness of health care can be improved through the active involvement of patients and families.
2. Collaborate with team members to analyze quality and safety problems/issues in the clinical environment.
3. Use quality improvement tools to analyze processes of care, adverse events and medical errors, and improve care.
4. Participate appropriately in analyzing errors and designing system improvements.
5. Value the need for continuous improvement in clinical practice based on new knowledge.
6. Demonstrate commitment to team goals.
7. Demonstrate awareness of own strengths and limitations as a team member.
The Quality-Safety Project Poster is an activity designed to expose students to the following processes: 1) identifying a quality-safety problem in the clinical arena; 2) using quality tools to analyze issues; and 3) determining an action plan to address the issues/problems. Students collaborate with team members and present Quality-Safety posters to the entire School of Nursing faculty and student body at the end of each semester.
Around the fourth week of the semester, students discuss the quality movement, adverse events and medical errors, the IOM Six Aims, and QSEN competencies in class. Then students form a team of three to work together on a quality-safety project during the remainder of the semester. Students are given 10-20 minutes at the beginning of each class to meet and discuss their projects. The faculty is available during this time and meets with each team to address any questions and provide guidance. Following is an overview of the strategy (see submitted materials for specific student guidelines):
• In-class Preparation for the Project: Students view the Lewis Blackman story available at http://qsen.org/faculty-resources/videos/the-lewis-blackman-story/ and review various quality improvement strategies that could be used to improve care such as root cause analysis and plan-do-study-act. In their teams, students work on a fishbone diagram related to the Lewis Blackman story. Teams compare and contrast their fishbone diagrams with other teams.
• Students Identify a Clinical Problem/Issue for Team QI Project – students can select:
o A clinical problem/issue identified during clinical practice. Examples include problems or issues related to staffing, patient safety, nurse safety, failure to meet practice standards, communication, etc….
o An adverse event or medical error identified during clinical practice. Examples include errors related to medication administration, standards of practice, procedures, near misses, etc….
• Each Team Completes a Fishbone Cause and Effect Diagram for the Specific Problem/Issue Identified
• Teams Explore the Problem/Issue in Terms of National Quality and Safety Initiatives: Link the identified problem/issue to national quality or safety indicators from at least one of the following Organizations. Teams are encouraged to link to more than one:
o The Joint Commission (TJC)
o National Patient Safety Goals (NPSG)
o National Quality Forum (NQF)
o Agency for Healthcare Research and Quality (AHRQ)
o Institute for Healthcare Improvement (IHI)
o Institute for Safe Medication Practices (ISMP)
o Healthy People 2020
• Teams Explore the Problem/Issue in Terms of:
o ANA Scope and Standards of Practice (2015)
o ANA Code of Ethics with Interpretive Statements (2015)
o Nursing Sensitive Indicators
o Relevant state nurse practice acts, regulations, standards of nursing practice, nurse safety, patient safety, etc….
• Teams Explore the Problem/Issue in Terms of the Relevant QSEN Core Competencies
• Teams Must Develop a Plan for Improvement Using the following QI Tools:
o Plan-Do-Study-Act (PDSA)
o Root Cause Analysis (RCA) using Fishbone
Students present a poster at the end of the semester. All students in the class must visit other team posters and complete an evaluation form. Most faculty attend the poster session, ask students questions about their projects, and complete an evaluation form. Students from on-campus nursing classes are released at intervals to visit the posters. To ensure students being released from class attend the poster session, they are issued cards in class and must obtain stamps from the poster presenters.
Students are formally evaluated on their projects by course faculty as well as by faculty attending the poster session. During the poster session, students are observed by faculty answering questions and presenting their posters to others.
Students are required to visit other team posters and complete an evaluation using the same evaluation criteria that faculty use. In addition, students are required to complete a self-evaluation and a peer assessment related to teamwork and collaboration.